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tr^ International 
Abstract of Surgery 

SUPPLEMENTARY TO 

Surgery, Gynecology and Obstetrics 



rUBUSHBD IN COLLABORATION WITH 

JOURNAL DE CHIRURGIE. Paeu 

ZENTRALBLATT FUER DIE GESAMTE CHIRURGIE UND IHRC 

GRENZGEBIETE. Bkkun 

ZENTRALBLATT FUER DIE GESAMTE GYNAEKOLOGIE UND 

GEBURTSHILFE SOWIE DEREN GRENZGEBIETE, BcBUn 



EDITORS 

FRANKLIN H. MARTIN. M.D.. Chicago 

PROFE560R AUGUST BIER, Berlin PAUL LECENE. M.D.. Piri» 

SIR BERKELEY MOYNIHAN. M^^ F.R.C^ Leeds 



CAREY CULBERTSON. M.D.. AbMract Editor 



Volume XXIV 
January-June, 191 7 






rUBUSHBO BY 

THE SURGICAL PUBLISHING COMPANY OF CHICAGO 

J» NORTH MICHIGAN AVRMUR. CHICAGO 

i«l7 



IMI lUIUMCAL rVMJMIIM COHrAHV 

I 

v.Zlf. 



INTERNATIONAL ABSTRACT OF SURGERY tti 

CONSULTING EDITORIAL STAFF 

GENERAL SURGERY 

AMERICA: E. Wvuvt Amonn WnxAso BAcnxiT Pmnic A. Bmrv Krrmv Dsaii B>va» J. P. 
Bonn GaoMB E. Buwu W. B. BmniAOB jomm Yoom BaowM Dav» QnBVBa II. R. Onsurr Romkst 
C Covrrv P. Gbbgobv Coiomj. F n a uuc J. ConaH Gmmk W. Cuut W. R. CosMm Habvsv Odmow 
I. Okihiww DaCocta rwotiBt Davbom D. N. JTaiwiii J. M. T. Fdoibv Jaom Pbamk ^^'— tt H. 
FiAxm Ehamuu. Pbibiid Wiiuam Pvuu Jom H. Gwmh D. W. Gbasaii W. W. GtAvr A. E. Hautia* 
M. L. HAtttt A. P. Hsmoc WouAit Hanur Tmhas W. HinrnMcroH Jabu N. jACsaoM E. S. Jose 
C E. Kabuui An«vt A. Law Roust G. Lb Onrb Dbam D. Lbwis AianBALO Maoabbm Eovabo Mabtoi 
RoDOtra Matas Cbabibb H. Mayo Wiluam J. Mayo Jem R. McDtu. Stvabt McGcsbb Lbwb S. McMmmnr 
Waxv Mbybb Jambs E. Moobx Fuo T. MvBnnr Jambs M. Nbft Eowabo H. Niobou A. J. ^^'ffrtt 
OB<iBtBS H. Pbcb J. R. P bm mdi o tow S. C PunoisB Cbabibs A. Powbbs Josbfm R A WS OMOtf H. M. Rkbibb 
Emhbt RocroBD H. A. Rovbtbb W. B. Sodobobb Cbabibs L. Scuwibb U. G. Sbbuo C. J. Ssm 
Jom B. ^"— — — Jambs E. Tmoitnom Hbbmam Tubolsbb Jom W. Tobmib Gsobob Tnxv Vaocmam 
Jom R. Waimbm. CANADA: E. W. Abcbbau> G. E. Abmbtbomo H. A. Bbocb I. H, Cambbom 
Jabtbb Haltbiqiy J. Albx HoTCBDaoH Fbanos J SncmBD F. N. G. Stabb T. D. Waucbb. ENGLAND: 
>L Bbciroh Anous AmiTTB E. Babbbb W. Watiom Qbvmb W. Samtsom Hamplby W. Abbvimmot Lamb 
G. H. llAKiKt Robbbt Milmb B. G. a. Movmimam Rosmtom Pabbbb Haboio J. Stobs Gobooh Tavum. 
IRELAND: Wujjam Ibblakd db C Wmbblbb. 



GYNECOLOGY AND OBSTETRICS 

A&f ERICA: Pbamk T. Andrews Bbookb M. AmrAca W. E. Asbtom J. U. Balvv 
Hbbmam J. Boldt J. Wesley Bovts LbRoy Bboom Hbmby T. Byvobd Jomn G. CtABB Eowoi B. Cbaoim 
Tbomas SL CctXBM EowABD P. Davb JoBBn B. Db Leb Robbbt L. Dkkimson W. A. Nbwmam Doblamb 
E. C DontBY HoGo Embbmfbst C S. Binn Paimeb Findlby Hbmby D. Fby Gbobob Gbixmobm J. 
GoBVB Sbtb C Gobdon Babtoh C Host Jossra T. Jommsom Howabo A. Kbllt Atanr P. A. 
FuMOAM Kboo L. J. Laoixsei H. p. Lbwis Fbamk W. Ltmcb Walteb P. If amtom Jambs W. Ifi 
E. E.M0WIOOMBBY Hbmby P. Newman Gbobcb H. Noble Cbaklbs E. Paooocb Cbablbs B. Pbmbobb Rbobbm 
P bibb b um Jomm O. Polae Wiluam M. Pole Chakles B. Reed Eowabo Rbvmouis Emu. Rns Jomm A. 
Sauvboh p. p. Soosom Ricmabo R. Smith William S. Stohb H. M. Stowb Wouam B. Su bib i— 

FBBBatKB J. TAOMW HoWABO C TaYLOB HiEAM N. VOfBBBBO W. F. B. WABBflBtA OMMB a WaB*. |B. 

Wiluam H. Watmbm J. Wmitbioob Wiluams. CANADA: W. W. CainiAM Wiluam Gabdhbb P. W. If ablov 
K. C McUwBAiTH B. P. Watsoh a. H. Wbi«t. ENGLAND : Rcssbu. Amobbws TSomas W. Bbim 
W. B. PoTMBBCiLL T. B. Helubb Tmomas Wilbom. SCOTLAND : Wouam Pobotcs J. U. Mwa oB Kbbb. 
IREL.\ND: Hbmby Jbuxtt Habtimos Twbboy. AUSTRALIA: Raim Wobbau. SOVTB AFRICA: 
If. TcMrLB IfCBSBU. INDIA: Kboabmatm Das. 



GENITO-URINARY SURGERY 



AMERICA: Wouam L. Baom Wouam T. BELnsto Jossni L. Bobmm L W. Bbbmbbmam 
Jomm R. Caouc Chabies H. Cmbtwooo Jomm H. CUHHU wa u M Raimm OofBBAB 
Robbbt Hbbbst Eowabo L. Rbybs, Jb. Gostav Koubcbbb P. Bbbbhi 
LiBBfOH Gbamyilis MacGowam L. E. Scmmidt J. Bbmtley SqctBB B. A. Tmomas 
HoaBH.YooMO Josbm Zbalbb. ENGLAND: J. W. Tmomboh Waibsb Jon 

MSKIBMOBAtAL MiTBA. 




W DrmtNATIONAL ABSTRACT OT SUROBRY 

CONSULTING IDITORIAL STAFP— Co mumiD 
ORTHOPEDIC SURGERY 



AMBRICAi t.CAne*r fUaMmAuaw W.8.BAn GvavMaiUva AunrR. 

i|.OBAcni VI— I f. Qitmn Jon I. (teMvwAif aw. Uvom tOMsv W. Lavsn QmmbB. 
W. W. ftmmuk !«■■ L. ^HtM Jon tUmuam Bmrni W. Rtuocm IIaut M. Souuiam Daw 
aUTAfiM MLAmmmWumm JaimLYoow. CANADA: A. Macssmb Poon 
r.R.OAUMiAt CummmUmum, DiOLAND: RoontJOMi A.8.T^mv OmmoA-Wm 




RADKXjOGY 

D. Cauam Jamu T. Cam L. Gibooov Cols Pushm M 
E. PvASua Hoiua B. Poono. 



SURGERY OF THE EYE 

AMnUCA: C R. BoAM B. V. L. Baowv U. D. Bums Vam> H. Houm Bvwasd Jaokkw P«a»3s Un 
W. P. MAons WiuiAii CAMvaotA. Pom Baown Pow Rooskt L. Ramdolto jau E. Wnn CAMivt D. 
WauAM R. Waan Cakt A. Wood Huam Woobo. ENGLAND: J. B. LAWfooD W. T. lliiiiHi 
SCOTLAND: GaoM« A. Bnnr A. Ujotiako \ 



SURGERY OF THE EAR 

AMBRICA: Wmmm W. Day Max A. GotMxioi J. P. McKukhi Noovai U. Pnact S. 

CANADA: R & Bnnrr. ENGLAND: A.R.CnATU. SCOTLAND: A-LooAvToun. IRBLANDt 
aWooM. 

SURGERY OF THE NOSE, THROAT. AND MOUTH 



AMBUCA: JoMwCBacs T. Umvoum BAamm Hkmaa J. Hauos Qdomam R. Hount B. 
tw o Ml CMiUM JAOBOOV Jom N. MacKoob aBoaoovMAnm Goqmb Paoix llAaaoa Jon 
Bmho. AOtnUUA: A. J. Baaot A. L. Bm«t. INDU: P. (nLnsALV. 



ABSTRACT EDITORIAL STAFF 
DEPARTMENT FDITORS 



DEAN D. LEWIS— >GMnuL tOMBBV n'l It 

CBABLBS B. BEBD — Ot— w u ii ■ aw > LANE- 

OHnnn NORVAL B. P1BB( 

UXni R'SCmflPT OiWfnOiWiiitwnni T. MBLVOXB BAK 
J08N L PORTER— OnnnHeBiMnv AwTteoftr 



INTERNATIONAL ABSTRACT OF SURGERY v 

ABSTRACT EDITORIAL STAFF— Continuco 

GENERAL SURGERY 

AMERICA: Camom, W. Aubm C K. kutamomo Domao C Bauoob H. R. BAsamn Gaoaos E. 
Bnuv. Waltu U. Bootssy Babmsy Bioon WALzn H. Bosuo Eoobmb Cait Otto Castu Pbuim M. 
CBau Jambs F. Cmamemax Uaoobb Com Kabi. Comnu. Lswn B. Cbawfobo V. C. David Natvam S. 
Days, HI D. L. Dhtabd A. Hnorr Domm L. G. Dwam Fbbokbicx G. Dyas Albbbt Ekbcwbibd A. B. 
■OBTACS Eiui PncBBL Uaac Gbbbkb Hsbham B. Gbbbitkb DoMAio C GoBooM ToBB Wagmbb Hakmbb 
Jaibb p. HnaotOM CliABiBt Gobdoh Hbyd Habold P. Kom Looam H. Lamdby Fbux A. Labob 
Hauby B. Loon WnxuM CABramtB MacCabty Ubbam IIabs B. F. McGbatb R. W. McNbaly Alvbbd 
R. NdcsBBii EooBKB J. (ySmx MATrmsw W. Picxabd Fbank W. PimiBO Eocbmb H. Foot H. A. Pom 
Ujkaxm B. Rbwjmo E. C Robsl Floyd Rilcy E. C RoBmasK M. J Sbifbst O. R. Sbyoi J. H. Skius 
P. G. Skilusn, Jk. Habbv G. Sloam John SirrniB Cabl R. Stkinkb Listbb H. Tusoukb Hbmby J. Van 
osii Bbbo W. M. Wiuomsoh Ebty U. Wouams Ebwim P. Zbislbb. ENGLAND: Jaios E. Adamb Psboyal 
Cols Absbos Eb m owh I. H. Hooonon Robbbt E. Kbixy Wouam Giluayt B. C. Mayboby Ebic P. Gooio 
T. B. Lno Pfeux Rooo E. G. Scbuboiobb B. Samobtbb Sobomim Habolo Ukott O. G. WtLUAm. 
SCOTLAND: Jam Fbabbb A. P. Mncmx Hbmby Waob D. P. D. Wnxn. IRELAND: R. AtKimoM Stokby. 



GYNECOLOGY AND OBSTETRICS 

AMERICA: S. W. Bamdlu A. C. Bboc Danibl L Bobdbn D. H. Boyd Amia M. Bbackwabtb E. A. 
BoiiABD W. H. Caby Sowby a. CBALTAirr Edwabd L. Cobxeix. A. H. Cubtis Cabl H. Davu F. C. Ebbbl- 
tman o M Liuan K. P. Fabbab Howabd G. Gabwooo Macbicb J. Gelti Luba R. Goldbiotb C. D. Haocs 
N. SnoAT Hbamby T. Lsacbatt Hmxm D. S. Uillis Jocm C Hibbt C. D. Holmbs F. C. Ibvino Nobmam 
L. Km» Gbobcb W. Kobmax H. W. Kobtmayxb R. H. Kchxs Jcuvs Laoockb Hbbman Lobbb lUnxL 
Laum Donald Macombbb Habvxy B. Matthxws L. P. Moucam Abtvub A. Mobss Robs McPbebsom 
Atanr E. Paoam Gbobcb W. Pabtbidob Wiluajb D. PmLun Hxuodob Srwiitt A. H. Sanarr Hsmnr 
Sanms Edwabd ScBUHAsni Emu. Sgbwabz J. M. Slbmons Camilb J. Stamm Abxolo Syvbmdobv Gbobob 
DB Tabmowbsy S. B. Tybon Mabix L. Whitb p. F. Wiluams R. E. Wwos. CANADA: Jambs R. Goooall 
H. M. LiTTLB. ENGLAND: Habolo Cbatplb Habolo CurroBO F. H. Lacby W. Flbtcmbb Smaw Clwobd 
Wanm. SCOTLAND: H. LstYS Mubbay J. H. Wiuxtt. 

GENITO-URINARY SURGERY 

AMERICA: Cmablbs E. Babmxtt J. D. Babxby B. S. Babbmcbb Hobacb Boixby J. B. Cabxbtt 
TftBOOOBB Dbocdowits J. S. EuEMSTABDT H. A. FowLBB F. E. Gabdmxb Loois Gboss Tbomas C 
HoitowAY H. G. Hamxb Robbbt IL Ivy I. S. Koll H. A. Kbacs Hbbmam L. Kbbtscmmxb Mabtdi 
KaorannsB Victob D. LBsrwASSB Woliam E. Lowxb Fbamos M. McCallcm Habvby A. Moobb 
SmuMO W. MoooBAD A. Nblkxm C (XCbowlby Edwabd A. Ouvbb R. F. (XNeil H. D. Obb C. D. 
Picsxsu. H. W. Plaoobmbvbb H. J. PoLKBY Jaboslav Raooa S. W. SfAWBA Gbobob G. SMrni A. C. 
Sioas L. L. Tbm Bboscb G. J. Tioiias H. W. E. Waltub Cabl Lswn Wublsb H. McCutbb Yoomo. 
ENGLAND: J. Swirr Joly Sowby G. Macdomald. IRELAND: Amdbbw FoLLmoM S. S. Pbomux Abamb 
A.McCa«nL. 

ORTHOPEDIC SURGERY 



AMERICA: Qbablbs A. Akdbsws A. C Bac mmb w bb Gbobob I. Baomamm Gsomb B. Bbmxbtt Raltb S. 
Bbohbb Lloyd T. Bbowm C Hxbmaii Bocbou C C ClUTTBBtoH W. A. Clabk Rosbst B. Corbld Albx 
R. Covrm Abtmvb J. Davdboh Fbams D. Dicmaa« F. J. ^*t«— »* M. S. "i— t— *— Pnur HorvMAa 



IKTERNATIONAL ABSTRACT OF SURGERY 
ABSTRACT EDITORIAL STAFF-CdiminmD 

OIITIIorefNC SOBOBBV- 



Cll.|«eni S.F. !«■§ F.CKshi f.W.Luis PnurLswni fMtM.iUammm Jaios IL If Acna 
ntwMj Mifiwi B.W^IiiHMMii B.W.OBa AMni<mnu.v tLomn0.f»aun II.A.PDnm 
BoMst a BiTtm |. W. Sivn J«di |. Smv Annm liiiwini Qusm A. Sfoa PAOt P. Svbr 
aftTiMMu* jAMwaWAtuci JAMM T. Waisim C B. Wuu DbFomr P. WatA» II. W. WlLOaK. 
CANADA: O. Otmm BvAm. BNQLAND: Howam Boob B. Bocb Camjm Nai 
B. Lamm Bvam W. R Hcv Ion Mousv T. P. McMomav Qmsum Bommi G. D. 



RADIOUXiY 



AMBBICA: Daw R. Bom Jo«MO.Botta WuxiAa ^taot 1ma> ■i^cm g. W. 

un«w AsmmHouon LMfOWJAoni AiMsrHiu -<inui DavwC. 

B.1>Mtt«t |.D. 



SURGERY OP THE EYE 



AMEUCA: E. W. AiauMtt N. M. BuKsnorv J. Sntoow Oamc C G. Daiumo T. J. Dimitbt 
J. B. CiAJi C. ft. Powua Lews J. Gaumttu Wmmt S. Giaolb J. MtiroH Gtaaogm D. Pooar Hrtttwrw 
Bbo«t Box GonAWS L Booob B. F. Bmo G. DfosAC Tbbobald WAum W. WAiaon. ENGLAND: 
f.yCvmamaum M. L. BwMW Fonnlfoon. SCOTLAND: JontPiAaMH Aran;^ Ht. H. SnoAn 

IL TkAQOAia JAMM A. WttMH. 

SURGERY OF TIIK KAR 



AMERICA: B. BiAfm Smvii J. R. Punona A. Srsucn EAOfiuii Rokkt L. Loooana Ono 
M. Ro TT W. a TkaoaAU T. CWknni. CANADA: H. W. jAMOMa. ENGLAND: G. J. ji 
SCOTLAND: |. S. PSAiaa. IRELAND: T. O. G»<ia«a 



SURGERY OF THE NOSE, THROAT, AND MOUTH 



AMERICA: Gaoaoa M. OMiBi M. N. PBaaara, Cabl Paean R.CiVBaLvMca Euaa j. Pat- 
loiL AOSTRALUi V. Maaaou INDU: joaaT.MaaMT. 



INDEX OF SUBJECT MATTER 



COLLECTIVE REVIEWS 

GMbk aad DwdoMl Ulcer. R. C. Csfty, MJ).. PA .CS., PtrtUmd, Ongm 

FMKtfamI TmIs oI the StooMch. Doodemtm. aad Puocu. Mas Kakm, MA.. MJ).. Ph.D., PUttbmttk. 
FMCtkml ToU a< the Uvrr and Kidaeyt. Mas Kakm. MA.. MJ).. PkJ)., PiUtbmgh 



»«7 
Mi 

449 



ABSTRACTS OF CURRENT LITER.\TURE 



ABDOMEN. Peactrali^ wound of. 146; Fifty lapa- 
fotonkspcffbrawd for gonsbot wound* of. 4A5 
AH-—'—'. Hypcralfletia ia, dJieue; dhgnortir vmlue of 
r»f»*— ' DoinU of hyiwinlii lii of akin and subcu- 
tMHie of abaoainal wall in affections of ab- 



vitccra, 16; gunihot injuries, capedaUy of 
tktttvcr. a8; MobOe bullets in, cavity, 33; pctfnancy, 
66; So-oJIed. pregnancy with postmortem report. 
6jS; Delivery oy, tectioa, 67. 180: Posture in. drain- 
^B, lot ; ConcctioQ of reb«ed. wall witii reference to 
on of buried silver chsin, in, Accidents due to. oca* 
iMioas. 137; InterpeUi-.smpuUtioo, 14^; DiagBoait 
of. diMJentioo in children. j6y, Obstetncal, Iqrstcr- 
^tOByt lo>> operation for c>'stocele. 407; Dtagaoais 
aad wnagrment of pregnancy in prese n c e of acute 
conditioiia, 4>S; guuboC injuries, 499: pain, 582; 
Radiotherapy of intra-. neo n laMna of testicular 
orii^, 583; gunshot wounds. 583 

Abdoaaal: See abo Cesarean section. Gaatrk. Peritoni- 
tk. Ulcer 

IhiliMMaii jlnlral Right, perforation by ballet; visceral 
kiions; laparotomy; complex Icsioas of the os iliac 
aad bfap articulation, 581 

Abaonnal labor. 68 

Ahaotnafitics of growtb. 61 1 

Abortioa, Uterine gangrene due to, 63; Pituitrin in. post-, 
cnrettcroent, 67; Treatment of retentions in. 414. 
Ctmngk mr nt-fcation in. of women with reference to 
bacfci ■bortiM (Baag) aad bacMns abortho-widani; 
617; Stnploooccas iihction aacMMCof ^MWtMMoaa. 
631 

Abaoca*. Complication of hepatic, a8; Periarticular, com- 
liiciriBg suppurative arthritis of kaee. 35 ; Epidemic of 
nvna form of acute infection of thiroat with, (or- 
aMtioa. 81 ; of lung foUowiag operation on tonsib and 
' air tract. 8a; Sa b p hien ic, 135; Cerebellar otitic, 
' aad curiBd. 196; CcrebdBar, sjrnytoma aad 
_ il». 477; Larynfeal. 198; of Hver, 
j6B; Tkyraid. with meation of two aew sl^ of this 



Co ay l e te. 



of. to 



B. of nana. 497 
AoocMory iiaases, Relatioa of 

of eye ia children. 79 
Aoddcats dae to abdomiaal ooatMloaa. 137 
Acyor bydr i a . Doodml nkar witb. 159 
AcUmIb, ha ia^MMtaaoe ia aoae and throat surgery in 

dM wB,8Bgia a on— luteri ae prtKnaocy^ iSn^ 
Afli|rfnd divciticiila. dIvcrtlcaHtis. and (iriiutvertiadteis 

of larp intestine. 579 



Acrocephaly. 476 

Acromegaly, and RecU^ghausen's diaeaae, 153; Histologic 
structure of *' y p<y by* » *"«* "^ ''yrT*y**t ilniimia- 
ta and their reutJon to, 570 

Acromical, Coraco-, dislocation, 364 

Acute appendicitis. 1 aa 

Ad en o m a. Malignant papillar>', of kidney. 536; forma* 
tion in stomach of rabbits by feeding witb '•■Ht*^, 
608 

Adenomata, Physiological activity of, of tlqrroid ghad ia 
relation to iodine content as evidenced bgr feadiag 
experiments 00 tadpoles, 375; Histologic stiactwcol 
hypophysis and of Bypoph>-sesl, aad their relatioo to 
acromegaly, 570 

Ad en o m yoma of rectovaginal leptum. 524 

Adnexitis, Tubercular. 405 

Adrenab, Spontaneous liberation of epinephrin iron. 30: 
Influence of. on kidney, 51 :Cy«u of, 188; laiaaHeol 
certain Ucton especially emotional disUirfaaaoea oa 
epiaephria content of, 516 

Adrenalectomy, Gastric ulcns foOowlag. ISO 

.\fter-treatment. of infantile paralysis. 38a; of gastio- in- 
testinal operations, 490 

Age, Influence of, and sex on bamo glo h ia. ayi 

Aged, Surgery of, 345 

Agonal period, Bactmemias in. 513 

Albee technique. Sliding graft and kangaroo sutuiv in 
fresh fracturca, 36 

Alcohol, and aalcaatalchild welfare, J05; Tricblor- tcrtiafx- 
butyl, anasthesla. 353 

Alimentary tract as focus of iafectioa. 490 

.Alkaloids. Peripheral actioa of opiam. with rcfereace ta 
bladder. 57 

Ambaid's ooeffideat. Comparative study of tests for 
rensl function; phsaobulpboacpbtbakf 
nitioffen and area aitrafea of blood, 
tioa. aad lest meal for reaal faactioa, 7>: bi • 
rical work. 186; Clinical value of. of aiea 
607 

AadMud'a coasfant. its diaical iaiportaaoe bi ariaaiy 

Anbardqaoticat. Value of , in estimatka of rcaal faactioa, 

189 
Amniotic, Cobaaaar, s n i lb s i iam, 5jj 

WalihIrbBiiag. ttmmt. ja; li 
i4S: r wii p a rj t^ fai mmuy 
at guiOotiBaar 



vH 



treadty; 



a65; In 
icw aadia 



of m«r«i- 



«6S 



vtt 



INTBRNATtONAL ABSTRACT OF St'RGF.RY 




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iip«MlniMMikMdaadMa,Mf;L»> ApoMMotk, Sob-, oowlag ol Np dni 4itali «llk 

il.K«:tociHop««iioM«BivlMN.ifs: honidMl«,io6 

I; l«^iM««4 iMttwHBi ibr MiliiMyM Ap^ontm lor moel oatf coalhnow imarforioa of blood. 



of . I m: Cynk dIoiBite of 



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iTfiopHMM •■ MCk, 49T 

> 1ft. umm/am, jsot Ow^dhi pio* AivnocMi, jM: Pi o miI o m of teal it 
iSi; Tlli'Hw iMlliijliiljl ■ImIiiI. ju; Iho, 16: FHtamlioa fai typlHid fovw 

I ol yto4«MHn 10. 4T«; ^»»ii>iiiic oillk oorto typhoid, iacUd. 119; Ac 

PMMMKlHHr «dv Mri. s«| aad dl<wtencoi of oral (wKtion 

^iiiil<fc.ia>yliriioadliMlMHlof port-. mkk$ opmio te, ttj; U 

MMP^fVBI. imMMMt NMMM », 544 rmW|'«i, Ml CMMIWl 01. Mft 

«ar MRMnr. lic ApMMMOincal flrtawi 

AiSa^taoeMM MlkeJ lor oonodJai faBaiw jt« 



raaNII.416; 



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kIoIm, j9v: Fbrtter 

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bouiag oo dfcfUno of te U fa fl M oitinr oteivod 
!• cvrkal rfl>, 49: Tortlag o«l SMdo-CotMo olgB 
lidebcuKhof. 



M o dot to. dMrttai of owlor, ^7 ^ opoo tide bi— ch of^ jqj; 

doN MMi OB lldMjr ipteil oord Mjorio^ 160 AitorMo, Stiwimt ood nBonsMow Hfrtwo of 

dot •• flOMlMC hdoita^ 47: of wmt, itc; mmI voum of tlw hoait. i<; laondiolo i| 

_^ . . — ^ — HpiMM oBk oMhofotloo ol ka»i lioib, hi wr ■niiiii, jgn 

tOpoMt, ISA: Artwlri,cot«ctmyMdtlowdooiocwoilliM oilfc 
^ fjft; Oo i ocago h od lnMfwloo.ji7: Poitkl puCImIbo of tho 



AflalovoMOk of HOMMl: qoMrapIo Oprtara wttli oldHofottoo o( lottt Ifaob, fai «v ■niiiii, jm 

■■IliiiiHM of iBlaaodhio vondor topoMt, tsA: Artwlri,cot«ctmyMdtlowdooiocwoilliM oilMdoud 

ItaaoMlc, of liiiiiiiiil oitMjr. i jft; Oo i ocago h od teMfwIoo. 47: Poitkl DtiBlrtti of tho oorto oHh 

l^HDVDHi fli IHBQHB Qi DBBCfHB WBQL mm CBIHBC SWjTt HRB^IC DUMI OQMOfUlflBB fli DH0O4NMWBB BBB 

al(i; of hapotk oitorv; raptam ofiw; p oi k iio i l tk chum in, »•■•. 49: PiUMf j aad, looiioo, 67 

■odaM, J94; Thonoe. wWod loor yoMs oao, J94: iniifkoitiiiiiii. Itiiltll f. ooil riihw ■■oUoidiol fhoiif 

Opo i o tl i o ii M ft 01. hi twr jm; A itmf i i Mm m u of nlit ipi lii ilm ilmioiw! nf niithJIil iltfior j . iji 

JipiiMHalidMai. dot lo ffoorfM: %■*— ■ of throt Aitoiievooooi, ootufteo of iHMnl; qoadraptB VpMH 

g— lUi— ddwililptowol ¥olo,fe9;TVooiootic. wlthorthpotioooflalOTndhliVHadvMpMMA 

SBK Chanlltt tnHoHol of oror. sio» ^a•MlM■oolk i«nlecModdtoooaniliBdoitefOMhot;|pMimcl 



jopsVMmiotMtfaMol of ovr, 5io» pao|p4iooowlic io|HOCMondtooooioniBOoitocoMhot;oiMonol 

MoMob of tmmd utmy: ■jo^Hiioiitidaiir of vhkh thrao coiolldi ood doohloteton of Wh, 909; 

lidlodhiBnbof,|ia;Aortk,iBdo|»rdot; Tteo- ooMvteoof tho poMoilorlfttfaittry aad vote, «m 

■Blfc.of fcllfaflwJ ailTi."tii>in» of ac 6oi Aithiitidti, Rolrtloo of pwotoU ibod ood iioiltil vadcto 

AiMnavaaoaibof poMMior dhWaitenraad voh^dM to. jeo 

Aal. T V M fi ol prartiat. »y; ffH rtap' of focctet tiart- AfthrititTv i K o iaplot l t la, d rf nn oo a i. i»; Foto coariiio. 



AiMrfavaaoaibofpoMMfar dhWaitenraad voh^dM to. jeo 

, T V w fl ol prartiat. »y; fflM op' of focctet tiart- AfthrititTytotiaploth la, drfnnaoai. jt 

OMal of piariiai). 1*5 aad oot o oa w d ttk of hip, leo 

li Jihiiii n I mill of tioitaiwi of toliinlDih of Aithiaan of vatiat tetarav amio. 158 

■liiirik.ka»-.a^.sos . . . Ai1hi«piHtytetoRiaiaak]tab.jl. . 




INDEX OF SUBJECT MATTER 



_ olfa«h««wd^t:ltellMd(er«b. 
taiaiM eonptett. at ilnwarh aad bowd op watto ai. 
*S7: "IvMtaHA of war vroaad*, ia MttiHy at iraat, aSa 



•57; 
A^nyaa, 



IS*: 



53a; TriataMat 



of, of aawbon* SU 
Aatc^yoa, Flactnre aTpnooMaoa poalarior auffoce of. 377 
ftHiiUhicHMaj pVtinmin nfnirafinn) la iafinlfci ptrilnii 



kan^ooi 
ttaa 



> ia fwtathwia diiaaaa, 19s: 
tioM ot BiDpe, 430; laivortaaca of, qraapitoaM ia oady 
diaaBaaia of tumor of eMabdhpoatfaa aagia, 640 

AunJ: SaoaboEar 

Aaikalar paMtktCka, 4J0 

Aaiit yiilia of odo at oid praona of, 55 

Aaoid diMaae. S94 



B 



ACILLUS abortiia. 



■I abortioaa 



tivo-aquiDua. 6J7. 
Rarkariw. Aaooadka of fifth lumbar ia rdatkm to. 4a: 
Rflla of aatapoaad vtcrat in caiwation of, and pdvk 
'JT****". ^ UMOf laSvay wnployBM. 191 
nif IM—Iii ia atoaai pariod, 513 
Bacteria, Lataat period ia grawtli of, i6 o; Co aaparativa 
tfll,aBdlwMBaBtiiiecell>toctrtafaiffliiiinea 
SIS 



Bactarial, Scro-easyme study of. protciBs, 391 
D a c t a riokcic control a» i ndica ti on of luture of war wouada, 

of urine in healthy children and tboee loffer- 
(roB extiaHuiaafy iafectioa, 274 

reMarciwa oa gas saB* 



paaa.617 



power ia iafectioa, 151 
Baatftdiscaae. Svnical treatment of. 134 
ria, Kootiae technique of. 163 
p^V****^. Pernicious awrinia treated by splenec- 
tomy aad mtematic. often repeated transfusion of 
blood, tnasrasion in. 133 




i>6; Surgery of, 
139, EnattBtatai caomaia; a ct ioa of. on heart, 374 
BBa ducti, S a ijBiy of aalMiladder and, s^o 
BSaiT, Suffny of falTbladder and. pumget, 360; Sor- 
pad ohaenrations upoa. lithiaais aad its treatmcat. 

Bi o chem i cal , Phyalological-. fuadamentals of hdiothetapy. 

Bi o cfa i iistry of tooical appBcatioaa with reference to the 

ow of boric aad ia septic iaitctions, 157 
Biolotical effect of raeatcn rays oa adoa, slo 
Biopey, Value aad daager of, in diagnnais of caaoer of sida 

Birth. Chid aalghlm twcaty-hve pounds at. 69 
Bladder, Per i plwia l actioa of opium slksloids with refer* 
cnce to. 57; Method ia operative treatment of eatrop^ 
of. 75; aatna, 73; qnaploaw in womea with iiifsrsnca 
to a s soda ta d tyaac wegical pathaieiy, 7$; TNaaoti of, 
190; TreataNat of , taawrs, 191 ; DivaraiaMi of ariaary 
191; Trcatmeat of papfBoBMi of, bv h||h fiac|iMinf| 
current, iqi; paritoneal faamdatioa of arias, upaiatory 
power of, 193; FufOMS of, aecfc aa caasa of uriaary 
frequency. 307; TiaaiaMat by radiaai of carciaaBM of 
praatata aad, mo; Prol ap se of uriaary. 410: Vesical 
calcataa ia^iiMunea, 436; Tnaaon of. snd treatmeat 
witt Ugj^caquency caatatiaatina. 4*7! Treatmeat of 
tuanfs of, 437: Kxtrophy of, report of case after ia»- 



plaatatioa of ureters hito rectum, S37: CystovaolQr: 
tta vahM aad Harftatinas in suiiery of. 538; iTMidBai 



$7* 



of ipiaal oofd, 635 
afaalawitli daMie 
bama aad ahar «l 



iacn 
wSh 



of aorta 



Bleod4at baMa aad altar aHaacMajr, 134 

Blood, Dinet taarfadoa of. iS4t CoagHatioa of, ia oaaca' 
tiva lalawaaUoa, tS4; cbaaasa m aUao rata fasiow 
; lamoval of spleea, 611; nu^tid > 
ttaOic baad; i rfftfrv atiftws oa, t 
ia aitarid walla, 49; Albma aad globaHa 
of baBMa, seiam ia health, avpirifc, Baaa> 
awaia, aad cwtaia otiwr iafsctioas wttfc baadBg af 
pJobaBajaa WaMsntnaiaactioa, «7» ;^plaldai a ia 
HBaMpUiia, 'T'i praCdaaj anai i^^baHaa ia 
bacterid infectioo aad faaasaailgr, 189; A p p arata a 
for direct and coatiaBons traaaFiMina of, 39*; «^ 
tract coaguUnts aad blood-traasfusioa, 303; Reia> 
fusioo of, from thocadc and abdomind cavities after 
severe hnaorrliates, 39a; Peraidons (hg a a dytic ) aa- 
cmia of piapMacy with typicd peraicioua, picture, 
414; Apparatus for transfwoa of, by sodium dtrata 
method, 474; Amooat of fat ia, stream of petaoaa with 
broken bones. 508; Subcutaaeous sdiniaiitrstioa of 
fresh human. S08: Vdue of ^deaectoeBy ia <BMaMa of, 
581; Use of whole, in h am oniM f e, tet; " 
of andear diaafes ia red. ceOa f 
607; Cheadcd, fiadincB ia variooa I 
in comparison with p nea ols dphonfphf h a lrin output aa 
an indfcatoc of opentivc risk, 636 

Blood: See also Embdism. Transfusion. Thrombosis, 
rucmorrhace 

Blood-prcsaure, djS; with reference to diastdic aad pahs 
pressure readings, 46; Vdue of , obecrvatioaa asada da^ 
lag surgicd prKxdures, 372; and prootatactoosy, 4s8; 
Rdatioa of, to angsthesia, 47a; and graphic vaaocao* 
tor changes in periphery during ether, 473; Low, not 
associated with trauoaa or hnaocrlMfle, 391; ParaDd 
study of. urine, and oedema in pregaaacy. 628 

Blood-transfusion, New osethod of, iS4; «ith paiaiha- 
coated needles and tubes, Ma; Kimptoa-Brown meth- 
od of. ^9a; Importance of proper dosage of sodium 




citrate in. 393: diapHfiad; deductioaa faoai 

cases, 567 
Blood vasatis. Projectile injuries of. 510; Reroariu oa 

cfbcta upoa heart and drculatioo of wounds of, and 

00 variations in locd physicd signs present at site of 

injuries. 603 
Bodies. Foreign, «i8 
Bone. Fat embolism in, surgerv; iad d ea o r aad pr e vaa 

tioo. 37; Transplaatatioa of, ia fractana, 38; Tkaa»> 

plantation of articniar aad of , f 

cartilage line, 38; Causes of anuria I 

of, ana joint coaditioaa, 58; Removd of 1 

fragmenu in pcimarv treatmeat of artflkqr 



141; Generd priarip>fs to be obairyad ia, traaspla^ 
tations, i4S; Eaparuaeatd. tu b a ca loa i a, 139; rUd 



ia, ta b a nuhi s k , 374; Circalar_coaatrio> 
i ia trsataiaat of fractarea of wag, 377; 

tioa of.ia Ita ralatiea to cdthratka d 

Joiat affectioas tiaalad bjr hdJiUharapjr, S9» 
Boaafrdts, Paibam aad Maitia baad b 

laaiaifca upoa asacaaaicd appHaacaa vacMM. 374 
Boaa grafting. Nav aMrhaairally aad aanicBBy a 

Bsethod of. 378: Treataaeat of paaadartEraaaa l>y. sot; 

Foar triab of, for loaaaa of tibial adataaraa. 593 
Boaa-BMrrow, S pJ ea a ctaaty fai paiaici oaa aaaaaia, 131 
Boaa autare ia g raa ida t l M woaads, 141 
Boay. Coogenitd a a o m a lira aad variaBoas d, skdetoa aa 

revealed by X-ray, 58 



l>rrERNATIONAL ABSTRACT OF SURGERY 




la. »}Oi iOUft. (MM4 bjr X'fijni, I : < \Kxgtv»^..( .w 

«k*m tab. immtd 



«4CltaciMlMfy«llipiarfHffallM» villi nter mtftm. jftt. Prtaw wy. o< i M Mt i* 

H»«»«t«l.iiiiiplklilKilni.in jM}IUkMcfil»«iMwiiMtte 

MMtarlMWi««HMlMi«ipiliMiMMadbMd, km tai igriiMMitiil to AmmIm dwiM ilM pMt 

Mifcilri<iHiiiiMlliii iiiili^fMl. mmHk,9Qlt 



■mm. %Im. lar MMliaa twifwM of waHoik umI far Ommm •! tMMidi. Vahw «f 



_ «»r 

la diigBHii of. »• . villi tmcomiaty owriMlw la >al¥» 
•ai|My, %m mmI aad lanaiiwU mrniaKitk oaanllMlioao. ti ; 

4;taMM,irii— *oLP— "**** ""^ '""' ^ RadhalcaMofcaanraf pjrlonM. Ji; RHolaKjrof.aad 

■fMMMMM at, y; (iMl-edl MMHaa al. cMoiAiaM, 1 1 s; Vaha of iiaiMlnuvr dimiaaUoa of 

■MMRMI^ !■ iHMhMiMI of • MMM bMOa dlMHVW iMaaMI la flMlfK fWHTWlf ia tUigBarit of. 




tis: Woitk of aa Mily X-ray oaariaatioa la, 4«o 
Ckanff of atafvi, RIfh iMat vonw low hMt la tMMaMat 
of, 6i: Kodhini tnataMal of. 6i; Twatmoat of. t6Q: 
Valat of mgiad b y t te rrrt t w u v in iwataiwn of. «qj: 
lUv ifMUatat of. 40 obuiaod bjr om of 

nMWHa la tioalairni *\m of prapkjrloctk 

rajriaf aftor opwatka kh. 401, ^iafprlM oi oi^lora- 
locy raMWigi aad dhfaoiii of. $$i 



Vary raraWigi aad dhfaoM of. $$i 

Pi^, dtnMMMi, 4j; Pio», Ha af M la 
6« 

800 oImi '^BBor. CoidaoaM. Saraaaa 
crmfi*. 4J 

:k. intra-. anuMiUtiaa of opper 9Mtnwhy , 
aw um inpttmcu owtaod* 165 
Caibahydnic fccdiag ia Mi|kal caar». 1 

ty. it, Sbrapad. fiot adddb Mf Mpparatfaa. 640 

r. «jfi; Kstnctioa of CMdaaaM.I»mrni«talaiof.«itlii9addnfMM0ttolMad 

la oalMaMMnMl Imi of tMrd aad orck. 104. Paw ill alii jilwn . los; PvfMMjr. of 

of. aad Aiapail luofa. 110; of ■lyfiiMmMiij 



Moaoatplal*. lAi; wnqyodia iMiirlitiil nllli iifni iiiiliai ilwi'l' "I"' "fl. iiiiwi 

la k«aial Mc. j6o i lp aid d M . i»$; PriB M i y. of valvo. 174; I i ff'^ *!»• 

naMM la kaing of. $9; Lood laicfaal iliaca aad racy caalciy as adjoacli la 




tioataient of. of atcma, tQs; Tioataical Ivjr 
of praoutc aad bfoddv. J09; Ray tnaUaoM of 



of breast, nt; of aMie. loH; Radical 
ba la, 154; UWaMte fair of patkats o, 
I^^KAL. SMr aad NManftM aa ■»>. raiioa. lai; fM.4S< 

V^ nMiiaii ■HjJMJrllliiiildhlMtiiMwol.faactiea.iai CiirianMi of owls. Radical ibdnadail onararina lor. 

of. 41J 169: Dliiaoiia aad caaMry Inalanat m, 4o«; PiHa* 

lioa of , lidkalid fai drflvary of thotnalMwlof laopinWi.by awaasof iidlMi.6«« 

iiiicaaMdk]rarfMlbani.joa; CiwiaoMJiow dMaMMioa of tibac ao as cytdM, tit 

joa; HM^ag aad wd l a wlto b Cuitfac pnaHnaMmwi. Mfag. 4arii« pncaianr, 411 

MHlai lacWoM la PHladi. 414: Caio. NokI for im^fpriMMl la. of iiiipaM 

!*•; P iii l Mii il iBi. ^t ^ ^ 

ClMaodt body. TMaors of, ajo; ooipaKlt. 'raMor of 
iBiar> or ralio-. s$i 
194; Caml aHllMd, TMbMmM of «ar vooads by. «•; 

Am Umm MliaM tit«M. j^ 

I. BMokfie OMrfaailaa of. graft after mta 

. . J« 

MMMitlawiHirbrfbycbMakaortldiaadcMdhc GMttalka la cmm of aMriat aqroaw. 404 
^f li jU i ^ . jn^ IUm Mj of op M Bll — pMcHsid far 

MMacoiaof immi, wCMMMaMniai 



MMMtL cat 
of ihtlailiD. c« 

toaaat of caM aa m to poMbom < 

at arathnl, i«o. C< 



Cbaorr. Stim, carad by X toagat _ of CHt •» m to poMi^oao or avoid Ma of . 614 



of biopsy la di^ianis of, of tkia aad 

M$l. 




INDEX OF SUBJECT MATTER 




,.-... by. •uktim at 

cwyiwif wtak other 

6s; PltjinA aad, tf fit of caidaoan 

ol orrii. 40s; Is cnptoyoMU of ocUmI, ia tkt tnat- 

of chfooic ulcer 

CMMorintioa. TiaBon of bloddor aad their trcotmrnt witli 

Nglhlicqueacy, 4)7 
avocaoMMi, tUBaauHpoaM, MO 
c'avitk*. Hoalag of old. of di«t. no 
rrphdk pwaiatinao, flainil ilgaMf arr of pwkpoe of 

arm 10,430 
CrwibtUor. Loolbatioa of, taaam — oaaial acnrct, $; 

otwc ahooMi dfai^HMd aad cvnd, 196; abwcM; 

ijra^iioaM aad daNnatioldai(aoni,477t localttatioa, 

47 



itiae oack. laiportaaoe of auial tyiaptoaw la 

cofljr diognoMi of tumor of. 640 
Corcbral. bcraut. ;; Diabetes i a ri p Ma s and. metabolic 

ccaters, 274 
Ctnbioapiaal, Trepaaopuacture of bteral vcotride ia 

. fuactioas of. ftai^ m(V Hi 
> of . aik ia pottoa^dittB. sM 
Cervix, Radical abdoniaal operatioa for caiciaoasa of, 
aaaauitery 



.It 



vtcri, i6q; Diagaoris aad cautery trcatawat of car 
dBoaM of. 40s; Fdliatiw trcataieat of iooperabfe 
caidaoaM of. bv aMaaa of radium, 6aa 
Conrkal, Chaagt* n nporior, qraipatbetic gaa^ re- 
BMived lor nM of wnahthahaos. 9; Experunental 
stud^ of drcoaMoftodaitatioB of artery iouaediate- 



ly distal to paitialy o rrl a di a g baad aad its beariag 
oa dibutioa of wihriiviaa aitcijr^ observed ia. rib, 
49: Two caa 



o^, aad cervfco fa dal reaoai, 57c 



570 

Cbarcool. Animal, in septic disease, 177 
Cbemical. therapy in caaoer. 270: Active coostituteot in 

tbyniid: its. nature aad f unctioo, 479 
Cbwt. Rocal|BMgmais of, in tuberculoMS, 58; Injuries of, 

dariai «ar, 109: HiiiKai of old cavities of, no; 

SvB^itoaH aad pasnacal p(aa raakiaK from wo unds 

of, «SS;. PWofopalawaary war woaads; gravity of 

pMNtiattag i w f it il f of 4 R 4 
Chiabirth.Pkfate.6io 
Chid welfare. Akohd aad aatraatal, J05; Importaaoe of 

liakiag up aO orgaaJMlioas for aMtereity and, in local 

health districts. 6jf 
Chldna, Appeadicttis la, 36$; Kpidrmir vaginitis in, 624 

alMhw aiyoaMle aad aaUa oadoaotiilis, 171 

Peetepcntiva hnaaloawsis as a 



«f.9t6 

, actmi of bfle oa heart. a74 
Chde cyt ectoBiy the operatioa of choice, 498 
Cholecy stit is, with aad without gaO-etoaes and Heseifira- 
tkiii of syaiptoBsa. 127; Early operation in acute, 127 
Cholecystcctoay. ladJcatioas (or, jo 
Chole cfet oetoaiy, Value of temporary, ia gaetiic aamMy, 

ChoicMealoaw. BUHiivc. loBowiag the LBeOddwcH aad 

rnHiB irrrrHtirw ThntfatlT^ nrrnnM, Oi 
ChnH a ch lorid e, Favorable action of, ia scar injuries aad 
scar ooatiactioaa, 27J 
iof pelvis, 387 

Pihnarjr. of (aOopiaa tabe foOoateg 
-• gestatioo 406 

of dfa«aoeis whea fcrJoiwial of, 

1 catgut. Osatoui sutures with. 591 




of CBcal laactioa* 

nj; trtaaai. 60s 
Cicatrices, Tnatawat of Iriioas of acnra>if«aks by radio- 

therapy of om-r. J99 
CIcatriaUoe. Nsiunl. aad ticataMat of haWitif fractana 

of lower jaw, 048; of woaads; wlatioa betwo ea siw 

of wooad aad rate of its cicatriaatloa. 398; of woaads; 

aMtheaMtical cxpfaasioa of carve rrprescwiiag 

y^f^ ^*mfifffi^ J99 

Claw-foot or daw^loes. $87 

Cleft palate. HarcUp aad, 84; Artificial restoratioo at last 
or miseing tiwurs ia coagcaital. and other deformities 
of aMmlh,645 

fTif^^f ji Pf fg ^fwft ol hypophyib to certaia. awailestatiaai 
ud therapeutic appHcatioa of its extracts. 158; 
vahw of awtaboUc studies of thyroid cases. 479; 
vahie of Aatbaid's coeftdcat of urea excrrtioo, O07 

Closure of breec h es ia cranial \-ault. 248 

Club-foot, Conservative treatment of. 383; Faedal plastic 
ia traumatic, 502 

Coogulatioo of blood ia operative intcr\-catioa, 154 

Coaguhtivc. Separatioa of terum into, aad 
tivc f cactioas. 507 

Coaculaats, Blood extract, and blood-traasfusioa, j9> 

CoeUnc arter>', I'nrccogaiied symptom in lesions of pan- 
creas and aneurisffla of, 263 

Ccefiobystcreciony, Tnaspcritoaeal. 18 

Colectomy, Poetopcrative coaipficatioas of Laac short 
circuit and, 367 

Coley's mixed toxins in treatment of sarcoouita; osteosar- 
oooia treated by this nwthod. 151 

Colo-epmloic. Operating upoa posterior face of itowiach 
by later-, route. 361 

Coloa, Prc»iitioa of obstmctioe of nsssagr of gas folow- 
iag opeaatiaas oa, 1; Coageaital de f orraatioa aad <!»■ 
funcoonaliiatioa of caudad Qeom aad, 25; S u perior i ty 
of ri^t side aaus ia handHiy of partial aad coevlcta 
obstruction of lower, and sigmoid in cases nnsaitod 
(or Fsdical operatioa. 26; resectioe aaditsiadicatioaa 
124; TrcafMBt of coastipatioa farcoasenrative 
surgical oonodioa of retaraativa di^ilaoeBMat of, 
1 24; latestiaal oodusioa dae to ( ~ 
of. itMitiag from old pfnrtratiag 
wooad, 494; Extraperitoaeal woaads of 
aectioa of crural nerve at its roots; suture of coloa, 497 

Coloaic iaiections. 1 ts 

Cooapeasatioo. Worfcmea's, bw, 520 

Complemeat-fixatioo ia abortions of women, with ipedal 
refcreaoe to badBas abortus (Baag) aad the ' 
abortiwo eqidaas, 617 

CnmpKratioa, aririag ia trratiwit of 1 

with thorioBS-X, 3': C o tri ba tioa to saii&al, of 
GSSBous aature of typhoid lever, $84 

Compound (ractures. Treatment of, under dvil aad 



tary conditions, t^i 
Coaceptivc capacity of 1 
4«o. 



lailal, p ylori c 
tioaafiMuoa of caadMl 
aad variatioas of boagr 
58; diaphragaratic hai 
^antoBM aad ticataicat of. 



woosan and dctcrminatioa of sex. 



410 



aadoefaa,ac^aa« 
MaaiaveaMhgrX 



-ray*. 



o(.origfa^$86 
3«4 



363; Tibial necudafthrosis 
Conjaactiva, Tabercaioris of , 1 
Ciiaamlie tiraai, Phafocytic power of, oeBs, 60B 
M of tiMae — raetoratioa of fai 
of nuaai. shoM be ate of 
Plea lor. ia ttwtait of 
J6 



aot IV- 



tNTCRNATlONAL ABSTRACT OF SURGERY 



•I ■ ' 



mat Aim Ml, fit 
■1 dk» I— liilii w^l m 
ItflivikiiMMMl «l «iIm, ••« 
t to fnMHr Mi iftMttkii, 114 



rawwtlM «i. to iMritag 
Mi liritoliM of . to totoi 



MQ ilMIWUM Cf« to 

mctkkt 
AttMkM 



MiCWMCOMOf VltoMi jflit 

dill pdito Mi oUnt, «riiiM&, ft«i 

ol«li, Miceamclti omm ta» 






lor nM «f . to p 
»ofpMipml.«t 



«lpnr 
4>s;Bi- 



■.liilfatcidiMdit»i«li 
fflCumidfi mmm M i 

py ili fc i * ili " " m ' , rfimlil 

?*T^M^II1b1| ^lllfclllllB ll> ll^llir^llB Aliti« ll«iln'M«MI ■• 

UMBJBVMBB^BVIHnOBMMMOaMHnaiOHOnHMB, JJ 
CHB1«toi,«» 

On* «•!». OMmoMr MMctoljr to, 40 

CMriy. Ommm pMl IMM fiMi K^pato to fiptoci. Ia»: 
liwfptoi«towyrir<laMhllD— .m6;auiwiol 
to«dCl?««*.a«liteetM«»a4i:Vatotoftotobar 




Ml htmOc 4mt, n. H]«iMii.«f kiiMy.7o;«riifi». 



»7»; 
■•jr.4«}i 



J7J! 






84: I^HA*. MMPCMCtoOMMi tOi; I^Bfi*, MpliC 

fad, 190; MtodM of tonrihiy dMi aad, tafacdoM* 

DWMftlOML PraauMHWM, 4S 
Ovadiid aaiiMdMB, I* 
DnBoii cyM d ovaiy to dM, s*J 
I d «vanr to toMsa, I7J 
n, CMOipdvt avadtjr d «o«m ukI. d 
>4*o 
" ~ iMdiiidniCBMi.it 

I c —haf PM tobdfc c Mlw»|^»74 ; 

lyplGd rwiilMrt tyaimM. JS7 

iHto, 44; Liatoity lor wioH, «o; 

I d omIIpmi iMMn d IddMgr, 

, d totoboMod liglaa. 147; Vdw mii 

d~^iapqr la, d cm^v d ikto aad mhom 

151; KoMtfM mjr aad iii «• toj 

161; RootiM tadbaiqm d iMiiam. i6j; D' 

d pi ttnnta aai llMir tiMt— it. i6j; d 

illilMtiBi to cUMiM. j6j: Biak«ic d 

104; Oiftcdtito d.^iLa dupd ppwMt c 

I J14; d CBDOw d radm, jM{ I 
j69i d cuMKT, j86{ d ■■ 

Mk MS* Md MMIMHMMl d I 

d aodi A^BiBliii coaMoM. 4ts. 
I d pdde aficlioM c 
r. 4t6: Mi aMafUMBt d 
c M di t ioM datot pnpMcjr. 4<7; 
rlMpH^ iMrdti d. 4*4: IdportMei d 

d p oltoi ny d iU i t Wwd hite ffiiiptiri, $tin^ 
Um, aai CMTntli'i tnaUMat d fmctSM mmI 
to b«oat a loti art, s«t: X-ny. d p* to dMHib i>4; 

llMtotoMindMl Ahm, vdM d 
d ^liiiitoiili ditto 
rdililnahil<iditoiiirtlaMd( 



*4a 




■diLd«Mnrtodai.s*i;Ui» iiinil,tocMii>il| riMito^B. SvMttttfaa d. Mi iHttocaidto. it 
Qn dcTliM lit illii toto HlwfaltiiitBMt(d ii^ n^to^ BiiUi . gm^ dili I. tonia. j t; Ew 
tMMn« sgt;iMtoliMd «mdit(BapBMdB,4f7 Mi toniftt fcMi fpntondadtol dwpc 



INDEX OF SUBJECT MATTER 



m 



DIVHtiPHAk OT WlBAfY MMdV. 

Oonri iHiea, PiH* of iMI «d 



DUocBtko, CoracD-acroaial. 164 
OiiplMMMat, Trmtmrni vi cornKd^alkm by < 

■Mffed oomcliM of maidotivo, of coloa. 114; 
lapertsKO of ooriy i o d o cti oo of fnctano wita, 141; 
Opt ni dam lor ratto- oad <lowBwud, of vtMVi, 194 
0f1h1lnah1l.hcMMw.t63 

i»t; A u ^/ilni , iM ii ilk i in - 
tioriMi of lupi iMtadM, S79 
af iMI witakfiig jtf< BUM IB, aSi 
ia o hd oi iB o l . loi; JUOMwini of pio> 
loctka affonkd by. of prasutioi •• prcttmiaary to 
opowUoa. 310; for pas cooditioiio bi pdvit during 

DrapjObtavotioM of afbcl* of , OS floooolk ^lUocter. 495 



OS, of ttk, 177 
VohrohH whb strmagalotod 



of, by alcor, ty, rorrinoBBO of 
MpropopOlory. caoMlly ■■odated with pr»«drtiBg 
riapk oloer. 116; Acute oad onbocute perforatioai 
of ■IWMrb and, |6o; Retroperitoacol rupture of, by 
bloBl force, 403 

Cottric oad, oloer in newborn, at; ulcer witb 

159: Diogaoat oad Migial treotmeat 

I, ukv, i6t; Cottfk aad, ulcer witb 

361: - 



Dry ttufwn of 

DaclibActkaof 

Dodat 



Sywn>toiHt 
•ad*. 363; 

Somical ticotawat of fMtrk oad, ulcer, 40a; Rocnt- 

■m itlognneii of. ulcer, 493; Gortik oad, ufeer. 574. 
Dufiici. Gmvid aterus, 172 
Duraate's metbod. Tubeicaloib of epUS dy u ^ treated by, 

194 
Dy^ihMia, DifTiat Anaqpoaa of 

oaddeatb, iii 
DyMock, due to flat pehrb, 30a; due to veat 

of ulei«o,3oa 



EAR. Double cavcraouft stnut tbronboDhlefaitio lecood- 
ary to adddb, iaiectka witboot i u »o l ro ai eat of mos- 
toid or oikwMnai fianeea, 3 1 5; Rdntka of . prcaeure 
to Boeo aad oar <fiiaaoe. 314; Preveatioa of duonic 
Biiddle. ■upparatioB. 545; Use of pure carbolic add 
ia MJwt f d ceaco of ffnr wk' tni*idh>t auppniatioo, 640 

Ffyanrrnrua cyit at left lobe of UvwttdC^icLato left 
bepatic duct, a?. 4ta 

Ffjaiapaia. 41a; Application of protsacted proctodyiis ia 
twat— eat of, 66; Laaibar puactare (or icUef of ooi»> 
Tulrioaa ia p uei pe r a l , 67; Pu erpe r al, 180; Liver aad 
kidaey, 41a; aa w a uh of craaial praaure. 413; Con* 
aarvamo treatawat of, 414. 627 

Ectopia iMtia taaaveiw witb tala^fle utcrua, JoB 

Ectopic imiMaey wUch bad goae boyowl fuBUaaa, 66; 



I ouivcBitflraa ICMMiiioa, 590 

'. by cofpocaooa, 6t 

M aid bi 

iaad.fai,cMa*n,si7 
iol,to< 






acadvohr tnatodpome uk 



tioa of ovary, 406 
of 
81 
EadotbeUoma, Peril hrlioma and. of utcrua. am 
End-rc*ulu. Fractur« of kjE, la oao b ydi odfl 
caaca, 141 ; Wouadi of fiaib aarvua by 
b aa ed oa fouftot opatatad caaea witb, 148; of op- 

49>: of trratiaaat of 
0^ aad aaUa-Joiati^ 

Eatcrecto^y, ( 

b/ - 

circufaur eateronbaoby. 494 
Enteric lumen. Exduaoo ol pyloraa by introfletioa of 

serosa in, 1 16 
Pataro aaaatoowia to pu a trr cunratare, 117 
EatanpiMlgr far wfcf ol ilgMoid ohatia c tion. 580 
Eateroatoaqr. M odlftfali oa of Roaa* faatvo^iterortoay 

ia Y; faatro-, ia T. m; perfactod toc ha i que in. 117 
Epidemic vajriaita ia raiilMn, 6*4 
Epididymis, Tuberculosis of. treated by Dnrante's metbod. 

Epidic^adtia, Suqiical tacatment of acute, 437 
Epidural iatiMpiaal tuuMr of two years' duratioo. 4a 
Epiaqpbrin. Spontaaooua Ubenoiaa of. fnua adicaak, <o; 

R6le of liver ia acata polycytluBaMa; aiact of ibarail 

off arterial blood anpply to Hvcr; luaodoa of aociMl 

aaiflsal to, aad removal of over fnaa 

ina i iM nf o( ccrtaia factors especially 

turbaaces oa, coatent of adrenals. 316 
Epipbyieal. Transplantation of artiailar end of bona i»- 

doding tbe. cartiagi Kaa, 38; Nav 

qaeatioa of boaMptaalic 

of. and joint cartilafla, a66 
Epiploic, Operatiag upoa poaterior face of stoomcb by 

intercmo-, route, j6t 
EpiplooD. Bullet in neat, mobfla ia banrfal aac, 360 



Episiotomy. Propbjrmctic, jjo 
Eptspadiaa, teeeataoa for mef of, in male, 541 
Epitndiuas, Odnmaar aaudotic. SM 
FpirhelioBia, of posterior pbaryngeal wal < 

dectrooaatery, 83; of laryai tnalad by 

«i6; Lobular, of poala, 437 
Erottoas of cervix, Co a trib a tioa to slady of 



whb 



ipic pw ^a acy wMch had g oM bpyoad fuB tiaaa, 66; maj^an t fwutlw of ulanm 6 a« 

MU^aacy ooaMiag witb utviaa Mogaaacy. S99t Etbart BsoovpoHnra aaa^npUc vatooaota 

Pi Maiy dw riB -a p i liei loosa of faBoyaa taba^lolkrw- pahibw j dariag, 4m; Wbfcb b tba mim, 

BiS WDCWBQb flHBftllOB* 40Oa IjFOIBIDwBX COQIDBCftCBfiCa OKIO0 AttQ O^D^H^L .407 



gMmQaT 407; Fol^ani, gsstatioa, 41a; Soans ada- 
takM ia oagaoaiB of, pvagaaacy. 6a7 

'•Mat, lfodwdofputtfa« up tract urea in ru ioa of, 
la lnlIy*flaMd poaitioa^ 36} Fiactaraa iavolviag, 376 
Bactridty, Masaage aad awdkal. ia aflai tiaalaiaiH of 
n; uTiffiitl of 
dcpartawat at 

Electrocautery, Epitbefioma dtp 
cured with, 83; Plea for, ia 
' ria,i9B 
t ia suncry of war, 6 18 
icatiaa of , 4>9 
,Fat.fai liM as— i ai j i,37 



of, to 

ia 



JiTC^ 



Etbflsoid, ObBoaa ttted of riisiHa»agfaphj of. aad 

iph ea oid ona, 431; Svgery of. labyriatb, 546 
EtbainidiHa. Cbroaic aad its treataacal, 431 
aad trsataMat, s6fl 

b^ofatadaaagmM.6s 
of dfviiWa aad datfmaidfe, tS 

tantad by. of aacralk Ifana; las- 
amcumr vMancooa loaowvu uj 
of capoule aad eariy atobfllaatioa of 

adoa, Pvlork, 1 16; of mdocuB by iatialirioa of I 
ia aatenc hmMa, ii6;I>aa«Ma of luMiliBal, lao 
bi •apadoff 
«f.« 




irfv INTRRNATIONAL ABSTRACT OF SURGERY 



pMferiHk filM. 1)1. rriiliM aai UMlail ««. r»i. m il ■■■ hi>o— wp i ji ImMmwm 
■iifcwfcfwfwiiK^— .lotOgiH ■ fa*. Mi j;; mmL Mmi mi aim ^kmaoma, im; 

Mi MMMM al, «Mb «i «l lafiin. ••:. KoviMfpa psMMkraitMB iii i iM. 4m: Abi m i ol. to Mood 



•ad liwt' 



VMS MpMBf W MBWmi ■■i fHH OMOBk i^K r^Kt HHiOT^« ^W) «fl^t Hf, 



. jmtimihm Mpi^Hl t*«t tmMviMMft- of nian pk. sm. Actios of y&ritmm, m 

tfMofpMMiiMMmi^^^rSlrafclKwoHribid i«aM of nUk. su: AcUm of «««Bl. o« gulp* of 

I of oMnr iBMrftaMjr dbWI to poitWIjr oKind kvooa oiofw. ••« 

hMi «i to fcwitM m iMimlw of «*• Pomv, Plnid ipko oad wborf doiir b iwl— ii of 



liow^Brtift»,4y ctii fiMtw of ■■di of, j>; T i o i fH oi JMmctmm of. 

«f lM(i tfi i^ «f «■• •< MKttoilnli«of lMriliqr.faic«taiBlk%|ifiKt«no 

lwjSTiliihi«iiMlii>irj «tt iilml I tkoftciUiv. 167: Nov liilwi lor 

mmatm, ^ mm mmemtk. tm kmm^limi l i o o l — W of Iwctuw o<. J77; Kiortowo of oocfc of. !■ 

hiio^idlooo li M r oof iynHu ooJr«od»ofi | ii M < driMkood,ji9 

lug to MboKokobot liMolt fMMOtfivo offMO, 177; PlMMod, Ailmovoaooi OMoriHi of, qwdnipli ItoMMO 



KlftM of lit OS kait, m; otedy oj villi ottkpotiaa of 

oad inaiptoauiiaa of Umoao. m; if^; IVHt-troaoMtic MOMib of. oitcry; 

of iton» 00 toctoo to itidtyuttt of. labor of «Mdi M to dhgoniii of ummkm, sia; 



lo Madr of oonn mciIbm Ttoi—itlr ■wriiiii of Ml. ort«y. tats 



MMM. jaft; aotoooMMali of loot oo ao aid PtHtMjr aad aloriMy; tiudr of ■ w m a t oooo. ovaiioi, aad 
dhpMM «ad MBW aaHaaal liMlil. jmj aMtao aad v^^mI movudm to lolaiiM to iMa 

iMMoaofalHltonrhodrtoMaolfoBcttoa, a — I jiia. 177 



•aoc RartHlaliiMlaBd.iaMaRlMoajBiiBaiVoao, nbaaidi^Oponiiaaaforoteriat,)*! 

••7.( 



BMi oa flBi gaaaoao, nbnl*,aMaliaaaior«tenat,s«i 
tmdtotioalTsUiyo. n bi d^a ato, Paitto^y caidfad. of Mtto w l logfaa. i»» 

Wto o lid a to oonvy of war aad Ha daaam; ibrahrtto 



liyoriBMBlaltoaak Rooac, oiWi oltrMa^rida aad wjpa umf k gka h, 16s 



ImdkmukKsn Whwi oM l a. M mwpo i— aad lottoi. 

taMli, PaiiMHBi . imim, i 



TmmmaKopf oad. of totorlor of taaA, nbaaanoaM. Dmmt, of iianiihaioi cauiinf dyvptaagia 

•t aaddmtli. itt;llaawvalolialoaddal. J04;otori,oaiS 

' of yaddw. Malfcod of lowwilu Iwaliil to. PftnaqFoaHtootariaoMKlad toonnttioa. 170 



Tf; ninfi of com oi, anar aapiBaiattaa of onton nafoafywaatooa. t^w wu w uoaiaMai ot. 



VIm. jt; TfeoataMBloflnctafv by aoB. 141: nMoaqn 

Ktivt aHdhMaaekaaical appaialaa Waoaliof Maddwaockaaca— of wtoafy Iwioaary.jor 

. «ftf FIfik aorvo. DiHaao aad oaifHy of. 476 

«f l^mnatogoiaaapk. Oii flHUft. Qp wa lioa of laiyi^, aooK aow inafwiBiwHa 

' Ua,oioaipMlirt*«m, j>5 mcto||r daripwd far iapivvtoi iho ladwiqoa, lot; 

all Tapoinphgr of pahnaaiy, aad 1ob« to iainta vldk 

of fafaaaina to tkaeaeaalaaia, 4ls 



la Mtovtoi labor; Ml arrtcruaaaidaatodtotoblBddor. 



^:!^T. 




at fal ftjt 

doaiM 

of. ti« Irralmml d plrofal. Jfi^ 



li^iuia- Mrthod for doaiai laifi ractavaglaal. 174; 



l^ltotolteof4iaaHOiofoBeaM7dBaHi«adMaHia<. j-miiov, KoUwd of, of iala h a l i o a tiAaiLli; of 






of toMto of. aad !■■• oiitotood to 47« 

i;MtoadlaM>aof.SiroUatoaqrtolaipactof. naanao^io, Mocteaical uactioa daviot for lodadtoa ot 

^ I of knara vltk aid of . 176 



fodal. Aorta aMMtoidWi aad, pantriiB,i«l Focal toJacttoia to lahltna to 
iMria. PwvaaHaa of, to aapptoaUva afpaadldtia. Hi 

I* Poaa» AMaaatofy tact aa. of tofactina. 490 

llareamcltoLjIb Ptom, Latobar aaaetoia of, dari^t pedaHc oatiaclioa to 

tmmm^mStmm,a» 

rmd aad idaBialal vpMk iSy: NoaiMototo aliMtM 

bytoiii|miiliaofaM«li.tot.aad.to aad «aa to ■aflmdaad. Uoad 01 Uaw of Mrtk, 

-.4T». s»«t.l« f f ctlu a aa «aaaa of afbluli aad -adry ob. 



INDEX OF SUBJECT MATTER 



xr 



Foot^OpcsBiivc irmuocBi lor ihwit— d gMHraw ol, 17; 

s66: OwMinfiMw 



of iM-. tai oM iMthli. 
of chib-. jlj; PriMUjr 



oa, spos EipofiflMaial 



opcntiow 
of. M aid to 



SM 



Fofoua, 



Foiccp*, PiMMi-^By ladkatkMH lor obolctficid, jm! is 
•opcrier ttiali. 411; roiatioa ia pwiirtcrt oodpito- 
'itioat. 4J1 
MorhonirmI UactiM davke lor lodvctioa of 
\ of, witli aid of i i io i eo c op o . 37^ 

518; Use of uosMtplMW to rcflaovc, from 

of. bMo iMMiBcivity. 6t; fine of ibcO f m te 
lillM kMO-joiat lor i«« ■WBtki; BO tncc of iafectioa; 
•sOsctioa of. J74 

Foioipi pnMdw. SoMBpdUity of man to. 387 

FotUtioo, Doc* tuper-. occur in human. 185 

Foot. CUw-, or dawcd toct. 587 

Fracturm, 139; of odoatoid procoi of am, 3s; of lower end 
of kwMfua, 35; Mctlmd of putting op, in regioo of 
cftooNJoiat in fuBy-ieMd pwitioo, j6; Intra-artic- 
mar, 130; of ics^ cad-vnaila la ooe haadtod 00a* 
Mcutivc cases. 141; Ciaaial, a48; Oa calda, 364; 
Piwcatioo of disability foOowiag, of os caldt, s?*; 
of traasvcne p roce me* of vcrtcbne. j68; of matiljariea. 
354; Paibam and Martin band in oblique, mrcbanical 
appKaacr* vcrna boat giafu. 374; in base hospital. 
375; iavolriaf dboa^Joiat, 376; of proooi on poste- 
rior sorfMe « asttataloB, 377; CompwrnJon. of fifth 



Ikt lower 



vertebra, 3^5* l^v'o anadiod routine, sot', of 
>tr ejUwimity or base of radios. 587: of 
of leaMir in duMbood. 589; X-nys of aucs of. 
of long boom at Musichmctts General Hospital. 
590 
Fractures. Trratmrat of, 140; of jaws, 4; Plea for conserva- 
tism ia. from rocBtaeaoloKical standpoint, 36; of hip, 
36; Fkxed spica and wheel chair in. of neck of femur, 
36: SUding graft and kan^uoo suture in fresh. 36; 
Trsnsphntatioo of bone in. 38; Open, br sraaple d»> 
vice. 140: by nail extension. 141; nadcr ctvfl ad ait 
itary conditioBS. ut; Importance of early l ad act faa 
iB,wilktfqplBoement. i4i;Opcrative, of patcOa, 142; 
of feaaor. 142: Nail extension in. of lower extremity, 
144: Nails and screws through joint surfaces in auto- 
graits and in, into joints, 145; Natural cicatritatioo 
and treatment of ballistic, of lower jaw, 348; Shortea- 
iag of healthy femur in certain thigh, with exteariva 
sborteninc. 967; Mechaaicai, under war condit i oaa. 
t7s; Medhanical tractioa device lor redactioo of, of 
MMoarm arith aid of nocoKope. 37^* ^ hnrar as- 
tiaaMes by aafl crtnrioa, 377: New iastniiwl lor, 
of femur, 377; CIrcalar ooostrictioo in, of long bonce. 
Treatment of old. de f orme d , and contracted 
'. 379; New splint for. of baawrua. 147; Results 
in, of arck of femur. 580: Is diagMiit aad coa- 
scrvativc, about to become a lost ait, 59s; of tfbm, 

FroeSa iydwwa c. Traumatic 1 

ol hyponlMii; typical. '*^*'"f im 
Fiitsdi cnainaa Mctta, Bnli« awl 

of ttaaavcrse foada* ImWom ia. 414 
Frontal, Intranasal SMiCffy lor rcBcf of 

431 ; Kxtemal. siaM opcratloa, $46 
Frootafis, Further obocrvatioBS on anatomy of daaa, la 



3.S7 

la scar 



FaB-tana, 



wMcbhad 

_, ,41* 

. THia of Hvw, 178; Acthre 

ioid« to OMaical aatare aad, 479! - ^ 

broipi a al inid, 905: Caaacrvatian of 



iat^ 

of 



tioa of, BOC icaMMral of orgaas should be aim of 
•arfHa, (13; Caaa bcariag oa. of pituitary body, C70C 
F Madaat faa of bwamcthiliiiniBByaii (BMCmfiiaai 
aa iadci of laaai, bob 
F^actioaal waal taata arltli ipadal rif waaia In i 
of adalBBd aacr a tio a of phtbairia aad 



180 



iad^o<ararfB, 



G.\LACTOGOGUE, New aad powerful, 534 
(;all-bladder. PoriloaitiB cawed bv bile without 
perforatioa of. or ble namafm, 111; Radiogiapby of, 
I i6; Anomalies of, aad bie pamacM, 136; Ruptare of, 
117; Surgery of , aad bfliary pamagca, 360; lawct ia, 
360; Clinical dlagaoria of. 3^9; PJthi^amh of, ia- 
ia typlwid, cholera, aad dlyandary, 370; 



Swicry of , 370; Saiiery of , aad blc dacti. 580 

it bout, aad 



Gall-stoacs, Cbobcyitltis with aad witboot, 1 

tioa of svmplooaa, 137; rHcfaoi la light of oacct, 138; 
SBbdiapar a gM a Ur colectioaa of pus aad gal dne to, 
138; DHfereatial di ag anab of, aad thdr ticatmcat. 

Galvanic muscle-nerve stimulatioa dariag prcgaaacv. 539 

OangHa, Changrs ia superior carvical qraqialketic, la- 
Bovad lor fdicf of ****|**1**t^***t, 9 

Gaancae, Operative tiaatmcat for thraataaad, of foot. 37: 
Radiologic diagnoais of gsscnia, 57; TYeataacat of 
gas, by intravtaoBS iaiectioB of h y po cMor ous add. 
59; Uterine, due to abortion. 63; Hematoma aad 
gaseous. 1^3; ruerpend. of extremities, 184; Inop- 
erable p en pb er al, 373; Treatment of gssniwM; 5301 
X-ray appearances in gas. 614; 
documeata, 616 

Gas, Prevcatioa of postoperative, paiaa, 346; Drtactioa of, 

Racogi 



Gas 



by X-ra^-s, 517; Rann g B i tl oa of, 

614; X-ray niagiwsis of. in timacs. 614 

. Treatment of, by intravenous injectiaa of 

lypochlorous acid. 59; as seen at casualty drariag 

sta t ions. 163; Bacteriological and experimental re- 

■laichis oa, 617: X-ray appearaaoes ia. 614; Clinical 

stadjr^of aaaerobic wouad ia iBC t io B ,6i7 

"^- of,gaagi«ae.s7;-. 

of, ga a g iaiM , 57; Tta m a tn ms aad, l _ 
133; compBcarfcB Mof war wouads, 383; Tk c a t a wat of, 
gangrene, 510, 616 
Gastric, pain in chronic ulcer, so; and duodenal alcer ia 
newborn, ai; cancer with secondary oMclMlar ia> 
vo l v emen t and terminal meaiagitic ooaipBealiaBa, 
3t; Perforatiag. aker, 113; akera loloadBg adnaa^ 

to oHologjr aad rHsfanrfi. 361; Worth of aa 
early Xnay eiaawaatloa la, caaocr, 490; ScgaKnial 
rcs actioa far, uker, 491; Sanlcal tiaatmcat of. and 
dttodcaal deer . 49 }; End-reaaUs of opceativaly treated 
Bioera, 491: Value of teaaporaiy cholecyalaabMBiy la, 
SBigcry, 498; and duodeaal afccr. 574; 
M«Bal_BMmMa of aipooBm to. jaioe, S77 

of pUigMHBa, lis; 
of acate dmcs pUagmaamm, cyj 
pilikalBV.scf 
of Raai,lairi 
y In T, 33 
Cadiu lalinlinsl. New inctrumeat far anp licatina of 
stitch la, nnfMT, itS; Aftor-noatp 
of, opmatfaaa. 490; S oma BadlalioBa la w t 
lay cvMMce of, Imfaaa, $75 
GaalMpaiy, Sappott of HoaMdi allir Bq«a, 490 
firiarrsilM rwiiBi. FiiiwImMilil laiiallgilifmi la lagaid 
to aauaaet of iSddoaaad mods of tpraadlBg la 
of leasals. 177 




66; f».i 



wH 



TVTFRV^TIONAL ^B^HTIACT OP SURGCftV 



'^-7Sj£i 




Mi4 ilHlf lilt to pmAmUm «f 

at. cMdMtoA. 40K pnlwn. 

•f. MCI to PItolartoMlMMetliplMtk. 411 

li». 5»;; 



•^"filte 



i^^B>^M^R» ^to» "T^"^^™ 

„___,«nil^ii>torai«etopk,4<« ^ 

M«iL«nMto«IMta|in{totoirif«alciMi| OyMoaladc, wmmn li IqrtoimaMiMaHaic 

iTtaHflMiMlMi WaynU, to im* tti OmMom dtc 

^ ' j iiMiUiT il d yrtd. 4i»ri<fcltM •> •■^ Oj ■iriulaghil, >j iifcB ljr tmr to wl^ to, Md 

mbmI 
hMMAMoodtoraMto s^;i 

i4 ortito oilMr Mm. aadol 



m-, 

4MJ 



of iMtfc 



112 BttoMur tM tftoltoMl «C 
, wtifc ytat to dtoto^^ wf^K oty my 

•f Mtoph^iltofc, fs«;_IUMis 

■M of. 1S7; fMMi^e cteapi to 

'•'.44 



iwiiki 



triU UJMANGIOMA csf 



sn 



5»7 



Md. to 



■ Ag^l— ■to p"**>< *« 4 4 ^ tocMM udiiv^nl rdM^ 

Atoi^Salqai. J*; lllilidigtr iwiitoalliii «f cu^ ll«MnBtk"jMBrfiet. Sphai in rrbtViSip to 

Higtow^ aitor WW ■■■ Ito . jtt; OwldWK. 4»; ■■■■!§. tfkmic m— to. and, ji; Two gpa 

OtoMtoL toMB Into MHtoi to npton cnMU totos of. kttnM, lao; SphMctotosr tot, Jmh 

towyptotoitowMlfffiiiililliiii .wfcmbaa ABqriiii7h«Mfti with nilMirtnnu. ij, 

l u I ii>i I i n t jg iiiiii 1 11 toMto-, Mdto teetoni tort, m» 




INDEX OF SUBJECT MATTER 



svB 



BMit, SipMitt Md riwyH Bto t liitam «f canmur 
mrtmlm aad vria* ol. 15; BoOm wooad of, pio|KtiM 
ia aalwiar ^rMHricdii wsO. 1 to; Sutnri of, as6; 
TimtatM of wo— diof,»ji6 ; tii— rfci oa 
And dmiBlkMi of woasBi of blood«w 

varktioM fai local phfrical iip» pnMU at rilt of i»> 

* — » ^ — 

JViCA,0O3 

BmI, Hi^ vena* km kmi ia tWifH of caaoar of 



alorat, 6a 
BUblkmpy, PH ji i n l nfial Wnrl M m l r o l 1 

ciS; Boat aad Joiat ■lortlnai Uoala 
flift CniiBM iipi, Tartiiv oal, apoa 



> tWBlad by. coo 

^^imach of 

H^paticaiMC— , Owf wicari oa of, tB 

Bipolk Mtcry, PftthofMait of oawiair aocnrii of Hvor 

aflw Hgatare of. umI to p wp ^ iarit bgr artarioportal 

•aatloaMMit, ji68; Aawmw of. raptan of Hvcr; 

pviaitaritii aodoM, JM 
Hipatk dact, Kch i nococnM cyit at left lobe of Uvor di*- 

dwighit into left, 27 
Baaittlaiy, lavcstiKatioet 00. trinimiMion of (HfmaoM 

la —cmrihiity togroirth of truHplaalod tuoion ia 

vaiioaa •baiaa of Buce, 51 
Henda, Oicbnl, 7; Upectomy aad aaddHcal, 18; 0|>- 

enitioa for iaauiaal, 19; Ofafiqao iagaiaal, te iafants, 

488; Stnagobttcd diaphngawtk, 3a; Eveatntioo 

noBB rocaffnoMcml viewpotnt 

Md whh X-nv, 33; 

135; Coofcattal diaphrnmaoc. op- 



fRMB 

DJa p h nn iiiatk. 

cnM aad cured, a6o; pocttnea, 37a; lafwHaal oc 
darioa doe to di^iBiapaatk, of com icnhiag from 
old penetianas taonooabdoayaal aoand, 494; 
Fortoiwratiw vcatnl, i o B o^r ia g laparotomies, 113; 
Gint vaatal, 488; CaM of lanbar. iia; into parm- 
daodaal fa«a, 135; Vadaal, aad it» treatoieat, 533 
H«Biai, Bdhtiagw at opUmaoWt ia, mc, j6o 
HwnBirt lwwaotatiaaMao, Bfanaatioa of, (uroCroptne) 

at iaiKs of reaal fnnctioo, 608 
WUbtf aMtbod, Treatmeat of Pott's disease by, 147 
Ig i M w qu eBcy current. Treatment of papOloma o(f bUd- 

&K by, 19a 
Kp, Woaads of laiye articaiitbns particulaily of kaee 
•ad, m; TVMtHMMt of, I m ctaw s, 36; False <ma||io. 
artlatti^ aad oo t eea ^y d ilk of, 500; Ead-«anto of 
imtaMat of tab«caM»of qaae, kac»> aad aiJda- 
Joiali, sos; Tfcnnaatk woertioo of, for war injinks, 
S9t 

aHath||38 

aaoocdov mpidly does iatact thyroid ^buid elaborate 
kwBiwiiMUliii^. iifl 

■bapoaoavolic eovamg of lame sknO defects 
witk.106^ 

■Baa, F^actara of bwar cad of, 35: Roeeaaliladoa of 
t«»4kMs of, by liiapla parkMtoaf nnwanHna. 38; 
New Mifiat loir faact ai ad, U7 
aiaob-bo^wibboaapcMi, 187 
Hyottid cyils of Iddacy , 70 
^Fanlyaia, Enct^B tailiwilfs of foediaK thyroid products 



of cartilsfinottt graft after seven 






hi abdaafcHl dianaa; diaaanatir value of 
I poials of hgrpanlpaia of aHB aa 
I of abdaarfaal tag laaf artfoai 
16 

Device for obtaiaiag latcial 
graa» of apiaa ia, 518 
Hyperovana la et iopathoaeaeais of utctiae akyxMaa, 65 
Hypertrophy, ffiiiiaHaaliaiapj ia, of t^yaaa itasMl, s8o; 
of prostate, 4sB 




H y pochiorto, Oaa of, of 1 
les 

gy poga at ik wats, Tao ( 

frag, sj: naiyagMd pitaitary; 
pharvas to. ajrsleai. 83; Rdatioa of , to < 
aMBMstataoas aad tharuMotic appHcatioa of to 
oatiacts, i$8: TraaoiaHf fcatai of poalarior loba of, 
typical Proehlidi syadroaM; diabalaa liil|iHiii. 357; 
•Tm-t-yir f\ — rm irf nni irf Iiit n p h j iaal a d sB n a i a t a 
aad their rdatioa to adoncgBiy, 570 

Joint, 364 

sy. >9S; Trsmprritoocal fwHo , 18; Valaa of 
vaaiaal, in treatnaent of uteriaa caaoar, an; Raaato 
aad tedudoue of vagiaal tirtrlirt a l, wr pforidaBtla 
aad cvali^rsctooaie aasociated with ahiaid giaariha or 
fibroaii atari, $24; Indications for, aa ahova by oae 
huadiad cases, 634 

tai OBa aiast haBic,CyBe ro l n gi ra a if »yiB,patieats. 179 
Hyaaamoaay, ObalaliieBl ahitnashMJI, laport of twdvc 

301 



H: 



ICTERUS. Two opeaated caaaa of hemolytic, lao; 
' S pl eacct omy in i p laa k i nam i c hagBM>lytfc.and Hanot's 

anrhons, ijo 
Idiopathic t^f^nffl * oataopaathyraids, 138 

Ileocolic, Ofaacrvatioas of effects of diagi OB, sphiactar, 49S 
Ileus during pregnancy and Dartaritiaa, t8i 
I l eoacol. Study and researaiea oa, lagion, lai 
Immobility after joint injury. 37 
Immunity, Influence of modem, reaeavch oa aargay, 516; 

Pre-operstive, with statistics, 563 
ImpiantanoB, En^rophy of bladder, report of case after, 

of areters into rectum, 537 
Impotence in male, 313 
Inaaioo, Plan and scope of lumbar, 151 
locootiococe in female; iu progaoaM and treatmeat, 408 
Incontinentia alvi. Sphincter plastics la, 366 
ladicatioBa, PicaeatKlav, for obatatiical iowaua, 30a; for 

hyalancloanr oa Mowa by oaa hBadiad caaaa, 614 
ladactioB, Uaa of pilatery otcact for, of labor, 4n 
ladaatilal me d fci a a aad aargery; tha aew apadalty, 6ti 
lafaat, Doca a dm i a i sfr atioB of oitaitiia to asolhar pa»> 

duce diffuae aervooa leaions m, 183 
Infancy, Pyelitis of, nM>deof iafectioa, 71; Pylork 1 

in. 576 
Infantile paralysis. Plan of trcataseat in, 41; ito 

BMBt froa staadpoiat of oithopodiBt, 146; 

•■«f f^—t—t<«i^ ^ 4^A^»Tj»fty \m t^; Safj^csl aspocta of, 

S67; Twatawat of, 381, sni Ahar-tnUmmi of, 38s; 

Astiac^ectoay (WUtasaa op watl oB) la, sps 

dad, Flaviae aad briUaat graaa ia 



of. 

woaads, 47 a 
lafoctioB. Toxi-, of ccatial acrvous sysleas; cHakal aad 
eiperimcntal innaHgatinn. ss: Pelvic. 69; Pp i driaic 
of severe form of acata, of throat, with ihiacsai fonaa- 
tioa, 8t ; Pravalaaoa of ckroaic aaoath, its aMUHpaaaft 
83; Daatal, aad awiaaric dkmm, 84; Oial, ia lalaliw 
to qraiaadc iafacaaaa. 84; Calaaic lu; Saoaadaiy, of 
JoJBla ia acata laiiilif at aiaiaBla, tjH; llalaf a < ' 
la, 151; Pahfic, la weaisa; aatfcalagy 
to treatatcat, 176; EzpanaBmalii 
laaaid to eatiaacc of. aaid awda of 1 

privata pracDoa! 



a Moodaa 




«»7; 



ia baahh. qrpMh. 



wm INTERNATtONAL ABSTRACT OF Sl'RGKRY 




IMi DMHM»af, 



It 



Mm mmI tk mmfdit ilkm ^ mmmtmnmlmm^ , wm Cfciiwlr, mmm^gb^ twt mmtmpum h i acait. «b> 

mmSmf UMt ■• fisM «l, 4«t$ Rnrtton af ipd twi— w ^wMn-, opwiiom. 4<o; m cImIim <t id 

■<■■» 4tt ; Tl— i m ^mmm — < ywiai, 114; <lipfcw|M> l fc fc«r«i» «< cafc a i wwrf Uf Jw gi aid 

IB fli IMMVHMH M MBHSMIt M WlMiy tnCI| ABB ppHMHtW* MCMMOB py WMMHOIM HbnMlfMIM 







«fi|iiM lor tw— iilr nipl 



>y ■ MwJfcggy, jty;fb iil, mt mm «l poll et p i y olo laiM 

: .olfPirfto'MlMnrmctlooBtcaniMmHl by iiMnmic, poffMh^ 

i|li Nol. Ii iJiltM 10 tnoMl MMikal Som ■■Horin— la mm^mm-nif rHilwni of 



by UManlk. panab, Mhik. oad buu l i B M ia, 499; 



lattaaaalal, Oparallaa of oaaW dKooipMHioa lor cm^ 



18; lalraaaMlta^prylorwihloidMwrfcltotald— illfa,4ji 
lam^riaal. Epkntial, twMr ol two yaan* damilaa, 4* 



k. I at law—, of aiqu Mi ga* a* llMapoallc MMa** latiartaom. loiictioa of o^ygn po as IhMapoalk OMi^ 

4? ttrr. 47; AbtanMioB of poiaiMMi ladUt by llHnaid 

MbofoiflniifUptyiaoailytioalaiMtof. ilaad to vini. f u a o al M to, h||octlo» to cwStat 

j«| oflMMau. s*: ^otaaana 3u and by 

I of. of fan aad Ja«» oaHalaad to «ar, «r«m tnatoMBl. icy 



lalartBk^ Tloaiawaloi. of Ian aad Ja«» MMilaad to «if , Mnua utatoMM, tp 



latabalka. Mccbod of ttoatioa of. taboi. Si; GtMfal 



|bh>' ' uQMaa flat to naMMt, uMBtUMMo by dnoct, to oponlioaa apoa boad 

' UM. at acck. loj 



naa(i,t44;Bail)rtiMiiimi« katc. 144: Traif I lata— Kopliua. »4. «i>; to acala ialtlaai obotmctiofl 

of «ar. of kaot bjr «ldt aad Br***^"***^ a i t b w toiy ac camai *ttb nmad woraa, 164 

aad iBial dmmm of art fca to thin . j;4: GaariMt, la laillpliiwM, Rconit. 00 laiaiaw of aatorlor lobe of 

kaa»-|atol; UmIt twal— al. sM; la pMl|ibMil aww alMlaiy badjr. aad oa prapcrtto of gimrtli-ooalial- 

piodMid bjr flMdm ommm, 14!; OaailMC of pa* hi caaolllmai, tetbdto. 61 1 

' wortarttoaoflaaimiw- laifohithMi. Cbwmfc cy»tk aiawtis or obaonnal. of biaart, 

jM; TKhahNi of b«vo 4Sa 

icja5:G«a*al,ofn#bmlaH«ai lodtot, PMok«kal actlvUy of adwawala of ibyiaU 

m, fi^ tJplan tor iiawator. is6: itoad to wtottoa to, ooatoat at iHdiariil by faadtof 

«ar. i6j; liBMBatfe. af Udaoy aad qpori aioato « i tod|inlw, t7s: Bev npidljr dM» 

■at, iatoct Ibyiwid itoad ctobocate Ms 1 

•6s; borflMflt, t^d 



MMi aa Mrtjr viaal coid, S69; IicbMaic coa ti a ctaia, s^ 

I of cMtocUaridB to Mar. aad tear Ivory ptotam OiMoa* inR tokaa boa mi 
omaKllaa*. ny. Tf tawl of war. at. to ^rfaal aaaial lo■^ to repair of csaatol lonn, 106 

aoid B wda i iil by aw - - 



to 



I by andmi awfai*. JA4. TwfwH of 

««r. '«oi: AbdaatoM wailiii. 40a: of iptoal cord to lAUKDICE. Cbraak obrtmcthrt. by paltottoo opcM- 

«v. $04; VtaMBc. of Miiiid ioimIi. %wi TtoataHat ^ ttoa. 99; Otoodatod. 1 J9; ^pliaoctnay tor bMB»> 

. «< i II liiiill M. to g l i al, 544 lytic, lu; Acow^ to iM obtk . iil lbud M K li iy .iM 

iaapMUe paMMnI papoH, J7J Jaw*. Twt ail ai WjfmSm at faca aad, wafakmii to iwr, 

laMlljiadia»k4toMaitoiiiflia,6j<l j; Hyparvyataafc ooaauieitoa aTto «ar weaadi. 1: 




af,st6 NatanI cfcatitoatfaa aaS twataiit of 

for aa 



_ aa oral akoway f lactaaM of laaar, 14! 

•47 Joiaaal aBoon, BfKt ob, of 090am to laatric Jofet, 

MBaiaania3aar>4S Jotot,naMiiliWlji altor, lajfmy, j?; Motbod of patttoi ap. 

af BBHdi,tlaBMiaiiiby.fai,aadia«toto Itaaawi to wibB of ifcea , tofd|| JawdpaJthia, 

ClfBBtoaa«BpBH»4IB l»;PaaolkilieaBplBaGBtonptoe»BBaBnndrfnal> 

tw B o v rt aCAntopaaa, r^t dai^. m: ntoblllii of kaaa-, 4bs Ctoan af onar \m, 






aravy of otoaacb aad, rti Acttoa af 
of nbUl, SI 



INDEX OF SUBJECT MATTER 



lis 



K 



ANGAROQ autvic Sttdii« grmit •ad. to (raih f racturet; 

". Jft 

KdUai iMHMljrtk mt, MO 

UdMyt, laiMM* of ■liiiotli oo. ct; Eflccu of ntootion 
!■, ol mfirtfai cankyod farpyakfiapky, 59; Uyvbtkl 
qrA oi, 70; P fcf iMw h aad wm^m tniUMOt ol 
I— Wgnint tiuMCB of. 70; TabMorfHitof, darioc pni- 
■oacy, i8j. wouadft, 1S8; Sutit aod ptotfe of. itt; 
TtMunatk injufin of. and uraccr. 189; Um of opaque 
amend catheter to locaUae mierilfi ia icgfam of, and 
ureter, igo; Liver aad* edimpek, ah; Afufidal ^mfts 
ia iauioa of awvable, 424; CoaicM data of polycyitic, 
415; Laifi tottiary uid lultinle cytu of. 42$: R*> 
aw»«l of floaea ffooi, 5J5; Prooactioa of . latiooa with 
•liplQfiocoocaa aufcoi ^y^it . sji^S Mal^pMat papil* 
laijr adMoaM of. 5j6; Partial acphrectoaqr for wooad 
of. due to war proiectile. 634 

^flM«»»^ riitneiti chalestcatoma (oUowtoc tlie Luc- 
Cildadl aad. op er atioa*. aiireilatiag taiaMaa, 81 

Kiflifilaa-BrowB OMthod of blood-traaifarioo, joa 

ItJMW. Wooadi of large articulatioaft particularly of. and 
hip, 54; OrthoaMMphic leeectioa oil. articulatioo. 144; 
Twtmeat of, iajims at froat, 144; £aily ticatoMat 
of. teiafca <r«ie|iriag thoM with oaieoai dartrucdoa, 
14A; YtaataKat of war tnjuric* of, without oMeoui 
fceiOBi or with intra articular fractures by wide and 
mtcmatic arthrotomy and total doMire of articula- 
tioa, J74; wouada treatod bv oackioa of aecrotic 
tiMoe; immrdiatr articaiar dwafacliaa followed by 
priaaiy Mture of capauk aad cariy BMibBiatioaof 
aitfcaiallna, 374; Ena-icsults of twataent of tuber- 
culoiii of qiiae, hip, aad aakle- joiata, 505 

Knee-joiat, Diaibflitics of, 40; Piece of ihdl free in right, 
for fhne RKMtha 00 trace of iafcctioe: extraction of 
foccin body. 374; .\aalaaiy aad misery of, 379; 
GuaiBot injuries to. tome luiicstions with regard to 
their trcatBMat. 586 

LABOR, PhialeH. 68; Aboonnal. 68; Leucocytes ia 
pmaaacy, aad puetperium, joo; Minafr—cnt of. ia 
bo r d erli n e coatrKtioas of pdvis, joi; Periacal aa- 
grthesia in. joj; Treatawat of weak, paias, J03; 
Sofiery during aiad for conm li ratcd prcpiaacy, and 
■iKarriacr. 419; Utr of pituitary cztiact for induc- 
tioa of. 4i2; .\rti6cial praaature, aad cxaarean op- 
omtioa. 539; Rectal vs. vaginal evaminatioo in, 639; 
Ureteral 6stula folowiag, Idt urctrr tramplantcd into 
bladder, 631 
Labjrriath, Suiyefy of etluaoid, ^ 
Labyfialhitii ia acute suppurattve otitis awdia aad after 
196; Oiaical types of. with ooaaMis oa 

LaenatiaaB, Periacal. 174 

I f hij— I. Raittcal cstirpatioa of. mc. 314 

Laae short cirrait. Postoperative cmn p lic a ti oas of. aad 

frfiwiBfi Adnoaai fbraMUioa ia stoasach of rsWfitt by 

fecdfaH with. 60S 
LaparolaaiiH. Obscrvatioas of fifty, p eifa nasd for gun- 

Aot woaads of abdoawa. 38c 
Laiyas, Wladow tesBCtoia of. mw resMval of intrinsic 

aMl%Baat (fiscase. 198; Fpi^HHiim M of. tiaalad 

by ladfana, jt6; l a yroved operatioa for iatiiaric 

■alaaaat roiaw of, 431 
LaiyagM ahwai. 198; Plea for e l e c t r ocaa t a r y bi treat- 

awat of, tid fia ha i i. loB; Opaiativa naatawat of 
EMMi by eAanal pkaryaaiMonr 

PJMtici, 316: Pl as tic WpMBflOB of, 

tracheal dafscts. 04S 



Q p tfSt i iTB of. 



lor ia^woviag ths tachafapie. 198 
' of year's wack with 




Laryagoscapy, 

8a 

Lilaat paiiod la growth of bacteria, 160 
Lavaft. aad saiMmMii of rarhidiaa caaal hi traaaMtk 

aiiiaiaiitii. 355; Rasohs nJushiHl fa^ of icaal psKis 

withia past tea years. 516 
Legs. Shofftcafag hw^. a ad wagthc^g short, jS; Fiac- 

tufcs of, cad-iasults ia oae haadiadcoasscutivccassi^ 

141; stretchiag aMddae, 353 

,«falM«s.6aa 

. d cysts of. 476 

«l OMHS as factors ia devvlopoMat of cxperi* 
»,a76 

Leucocytes ia pregnaacy, labor, aad puer periuai. joo 

Leuoocytosis, lodnoed, as aid to suisery. 45 

LiabOitv for wrong •liagyrrfr. 60 

Libeiatioa, Spoataaeous, of epiaephria f loai adfcaals, io 

Ugatttfc, Separate and simultaaeous. of oonaary artcrw 
aad vdas of heart, 15; for vasadar ii^ariea, 156; Ar- 
tsfior eao u s aacarisas of fsa Mtal; lya sdf a|ils, with e>- 
tiipatioa of iatensediala vascalw ligMsat, 156; 
Artafioveaous jugaiocarotiasBa aaaansas dae to gaa- 
shot, of three carotids and double-ligatare of vda, 
509 

Ligating the iatcraal iBacs aad Percy cautery asadjuacts 
in trcatmeat of caidaoaaa of utcras, S93 

Limbs, Scoliosis acooanaaied by pfsssan paralysis of 
lower, 41 

Limitatioas, Vaodae therapy, its poarihBitks aad, so8 

LipectoBiy aad uadaUcal hnaia. 18 

Limb. Prosthetics of lower, 143 ' 

Lithiaatt, Surgical observatioas ^loa UKary, iu treatment, 

37a 
Li\'er. Cchinococcus cyst at left lobe of, disrhaiyna into 
left hepatic duct, a?; Abdominal gunshot injuries es- 
pecially of, a8: R19U11C of, 30; P edu a cuhted Uuaor of, 
1 2 S ; Traumatic saiigefy of . 1 j6; Tests of , fuBCtioa, a78i 
Psthrynisii of amemic n e crosi s of. after Hgatara of 
hepalfc artery aad iu prop hy l a iis by a rt srispart a l 

aaastoasosis, 368; Abscess of. 368: A isai of hm- 

atic artery; ruptuie of. periarteritis aodosa, 394; Rdit 



artery; ruptuie of. periarteritis a odosa. 394; . 
of, in acute polycytluemia; further observstioas oa 
cflect of shfUUiag off arterial blood sapply to Hvar. 
" aaiaad to cpi a ep h i is aad iwaoval 



reactka of aoraMi 

of liver ffoai dicahtioa. 397: aad Udacy 
41a; Piagnnais of maMgaaat, tuasors, 498 
Local anrithrshi. 103: Rectal 

thesia. las; n^oBtl aaaathaala la 

Locaifiaatiaa. of cctcbeBar taaHis, 5; of 

ad baBs by oae ladingroph oa oae plate, sSi; Ccro- 
beflar. 477 




Loag boacs. Study of X-rays of cases of fcactaro of, S90 
Lower asticad|y. nactaics of, or bass of la J h w. 587 
LafrCaldwdl, CiI smI w ch o hata a Hw M Mlowiag the, airf 



Loelk 



Laasbar, 



af,fai 



81 
aad obstetrics. 



; puacUuv for rtlici 01 ooavaWoas ia paerpcral 
e c l aai fai a. 67: hsraia, ita; ii aai l aii of fcstas duriag 
imilaMr cstiactiaa ia iatcrat of Hie of fatas, iSr, 
Vahw of, ptartuwi ia oaalal war w s aa d i. a4it 
Aaiaro-ialarad iaoe of thM, vartibn. sM: Plaa aad 
scope of. iacWoa. isi: e>K^>M^mb UMsss. 356; 
iflh.v8rt8lim.3tS 
of . lagioa, t47 



INTBRNATIONAL ABSTRACT OP SURGERY 



vliktH^allirfkMiMM M«4aL Mmi MMdoiMi bImi Itr ( 

AMMi «!. MhMii tpMMMi «• mmIi aai «p» IMhii SlMi Annr mi Hmy, mm ol lit ■■■ 

tens MMiM il cMa !■ mSmiS pHOt mA w. ^MTlSpMMi il ' 



JnpHMm cMmMv, TvMttMMl M tnf waai vMl, mm WMWipnc iMipHMnM* manic cum wwi MnMwy 



Mi if iMHll 

>«f.<" 
PulMkck fUmm at, 171: 
_ wUa. *m; witk lilwiet to It* 

!•* MHCtlM if luyM lor iMMVil if IbUImIc. M wi t nM] 

Ims, I07! Wi 

'^^idi« im if 

t lir MtevMic cMckM criki Aio 
d Mitahnic, DlabilarWI|Ma» aad oMAftl. cMian, 974; 
■I* ahkal value of. iladlM if llqrraid caaia. 479 

of atonM, 6a»: 9lady if nfa- Malked, ThynU dkmm aad pnant, of ofwathrc traat- 
' la. BOirtlM of talaras, «t« aMSt, 107: New. o( hieod-tfaarfiwtnii. 154; C e n d ilwa 

anof. 19a tfaa of lacwit, of tnuMfwta with huBcatfaaa aad 

(rf. liMae alivlaBid la adb, liS; lackaiqw. J94: Coapualivi valaa of. of 



Mbof.i>aa<.4ti; W ii M «i T) H HY dfcMii .„ MttaM>,st> 
aadto«li»siac 



S7t Miqi.PriaMi79MatoaiPWtaRmai11.60e 



ik Midviivr. MidilMiM, ia iwaJMan. 185 

Midwivw. laviftaaoi « fittiai Mdksd pnctiliMMr airf, 
riitlilcilj la illw tiMlawl if to ja-ytan wiUi local iMahh autboritk*. $34 

m wmdmm> aad liiro rlww MBtonr. Twatownt <rf niaainiinit (racturc* uadv dvl 



at OMBMHad dHMts aad caaoa, aad, OMHtttkMM, 1^: EaM^pacjr t j "luT^ni la. 

aanvx; riafde awdJlratina of g i d lol f aa m U^km 
dih. Owafc cy«ic if ■haiiiBMllaiidaliii if bwaal. ■ ■th od if ai witartn a. 165; wm^mf. tMj 

4i* MnrpMai Kyrwciaa awtfced d yiialM cHMhlrth, iSj 

told.niiAiiiii«BiiairiawtlriainyitmnMBad> Moaik, Aorta lafirtlpai pnoHM ia. aad tlmal. 6j. 



jis; RMalpaapiVkgr if. aMal, 9s: Omo« if toafat aad loar < tot ; Ck 

' "* ** r abeal. 



gut; Wiiicai, apwaiiiM. S4S «. a47f TnatanC m aaipMai omaat aaei 

Mrt illfcii^ ikato. aad JadrfgiaU** i^« gmaialif. MacaaawintiiiBii.DaBwaldhtoaaifpdhflc. 176 

in. P— Mt <a*wau ai ffaaa tiiaawarii ialow iat MaKit, Aitlawaa if vartaa tamaai, isa; Dinct a 




Miiaa if paialrnd. jM; Oalvaaic. 
ia. aad fortal Janwaaafy. sto 

M filar, Niawllmlna bjr awaaa if l aa w ^a toil . 
far, piaalatloaaiato pandyaad Made iafadali 

ift MyJeiLla. Midrtpla, irilh dhr Mrina a» to ila i 

te; Rilatiaa if . ,. «t|i «rji>_. ,. . „ _^ .^ 

Myana. KMMvai m ■■noBai aa^^. S94« nHv>favnL 

of fool aa aid to baitor v2»ofviiraalaiaknma,iffBadBi,4ai;OHiallaa 

w a ft . 9M la caa» of atoriat, 434; aad X-iajr t iialaiia i . su 

bjrdnlBafeofpiatiadcs Mjmaata, CUorida if aae ia atoriaa haaMfi 

f to; af tarato w i rtiw a. by ai wi a i ^ j m I i m lai i iiBii t il l ii. 171 

if ta%wi<Bato aato- MjraaaaiBaaa^ BMaijr < tnatod bgr X-cajra. 41 

i4ff iatniiari iMlnBtfai^ jdi* 

rf tmamm aadw imr niiBHii . j7r« MAROILB. Ctatoiiaa < aad Rabm paKw. sis 

dwiaa far ladBcUii tj fiaHawi if faitorai 1^ NMl.'naBlaMaK6aA 

N if liHBicipi. ST*; Aaatoair af pralapH of NUL TVtotail if fiadaMW, 
villi oaaaMaaiiaa of. p iia d| <to of ti» twpait, lataetonaaf lo«araBlMBB]r.i44ii 

ioial aarfaoto, aas; TlnattaMi « 
if. It iflaawaiMBlaiBbsr,«Mariaa.|77 



INDEX OF SUBJECT MATTER 



641 



Md. lalKtioM to 



M wWiipKkl 



Wwal, Pot-. lafirtioB ( 

Mpl»iti». 107 
WMOpwrywiwI. Rcktkw ct 
tnl tyttmtic dinraHi 

C^eatrol ol. ud voaidi^t o( pccgBucy by iatim- 
ii|i«ctioat ol coffiHi hrtmn «Ktnct. 41 s 
Hack, 'nuMMB of. Aftd tpia*. 7; Pnaal Hatw ol caidao- 
' ' MiMMi 10 hMd aad. 104: Local 

ipplBM* to lapkoe a, ahookkr- 
joint. JO 
Noooik. PaihaiWMri* of ■■■ mlr. ol liver alter ligature ol 
h^Milk aitaiy aad its pcophylaxiB by artcrioportal 

104; Aiphyda. 5ja 
ol intra* 



,ol liSoriar eiji;ia, sl^ 
Ht^knttmuj) , Partial, far khtaoy woiad due to war pcojec 



O 



BSTETRICS.aad 




HtfSSS^^ 



POMaaial infcctioo ooavBcalMl bgr acute 

_ «07 

N«plmifithotoa^. RcNlt» ol operatiom lor extrocttoo ol 
rand calcub with lafcwoce to, 424 

Uio>, its ripdfcuoe aad dalactioB. 71; RAdio- 

papUc ^iiMb «l kgrdiD-, S35 

of cawhrflar taaMrs; aanial, 5; 
Mrtiptfam niudiac fiw traaa- 
phTatatiwi ol pcri ^w ta l, 4^; la^wiei to pe rip h er al, 
p todacad by aaodem warfare, 148; Wounds ol limb, by 
war pmiaotilaa, 14S; TranaplaaUtioo ol. 149; Waller*! 
law and theory ol t r ophi am ol, 369: Gunahot injuriea 
ol pcrutheral, anatomic invcatigatiao ol inner atnic- 
tare of creat aarv^traaka, jWj TraatBaot ol Icaiooa 
ol. ttuaka by ra dJotha iap y ol nerve cfcatiicaa, 399; 
DHeaaa aad aonaiy ol nth, 478; TBc h afa m e ol, ra> 
pair ia tnoaaanc injuriea, 506; ExpariaMatal coo- 
tf itnition to atady ol, tf^jiff'T and raaCoiatfaaa, 506; 
Gunahot injuriaa of peri p her al, and ticatawat, 596 
Nenre-hloddng, Inacaaiag uaefulneaa ol, or regioaal anca- 



Ncrvoua, Tozi-infectioa ol central, ayatem; dinical and 
eipefunenlal iaffrigafion, 55; Doaa admiwiiliation ol 
pituitrio to aaolhar produce diffoaa, kafaaa ia iaiaat, 

Neannhaaic. Gjraeoakaiicaafsafy ia hyatcw^,i>aHaafa, 1 79 
NaannDCa RdatioadDp beCweea gyaaoongic aad, ooa- 




Direct. ol paralyaed aaaadea, j86; by 
ol innervated imKular tiansplaatationa into 
pacalyMd muade in facial paralyria, 568 

Newborn, Gaatfic and daodaaal olcar in, 11; TtaataMat 
ol M p h wda ol, 03 

Nipple, Sbnaa oa nget^ dlaeaae ol, and ita estramam- 
aaaiyoeearraaoe, S7i; Bleeding, with plaatic operation 
apoa bw ae t , 57a 

Nitrogen, Xoa-piDl e ia. and urea in maternal aad foetal 
blood at tiaae ol bfarth, ot 

Vitroua-oaad e . Recent r mamaaararinaa with, aad eayg aa 
in obatetrics, 303; Vm of, aad oayfaa ia aaapary aad 
ohacctrica, 422; ApoBcatfaa ol aaod-aaaociatioa to 
uoece*ncaa vomo^Deo ubb 01 icwDvwi^^BBe, vKthbh hbb 
bed ia iitiatiea, 493; Which b aafer. ether or, aad 

NoaaTAddoM^ ita taportanrr in, and throat auifary ia 

chfldrea, 80 
N op ope rati v e traataaant ol otitia aMdia, S4i 
Noaa, Kalatioa ol ear preaaurc to. and ear diaaaae, 314 



Novbealae, Tonriilettbmy under, 451 
Nadaar chaagea, Octuiicace ol, ia red 



aad oaygaa ia, 
Uaa of aitroua-oaide aad 
AnoHealioa ol 
dTtoopdaa 

tttratka,4<j: 
$tA; laiaaaoa of halic 
S>i:P8ilaaaia,6io;aa 
Obatetrical, awiary a aMdai 

in relation to gyaiacological aad, 
c o effi cient ui, worit, 186; G^ 
nndrr regional aMaatheaia, t^Hi 



Paatwv iaL jaa* 
>aa ^iaryaa^ 4»»; 

aad bey ia- 



ia gyaaeabDr aad. 
lacoaBlnr(ta| 
184: SjmUMe favor 



otoeny with report of twelve 



•01* PnaiMlpdav 



Of IM 



I for, fofoapa, fot 
Obatmctba, PiiHattea of. of 

operatioaa oa ooba. 1; ] 

ty. S up arfae tty of ligM 

tnl and ooouikte, of 

caacs unsuited for radical operation, a6; 

118; Mechanical intcat^Ml, «6t; lataaaaaoeptioa ia 

acute intestinal, oc cun i n g with rouad wonaa, 364; 

Enteropiasty for relief ol agBMid, ^ 
Obatmctive, diroaic, jaaadlce bjr palHative 

ap .....^ 

4»i 
Oodoaioa, Partial, ol aorto with ....... ....,., ^...^^^ 

tiona oa blood- p r a ea uwa aad ch ang r i h artecial aula, 

40; Chroaie aad p ra gi a aai te inteadnal. by 1 

fibcoayxoaa ol aaall inteatine; entcrectoeay 

circular enterorrliaplqr; recovery. 494 
Ocular, Etiology ol, woaada ia war. los; 

wonnda ol, ^obe; thair tieataMat in army, 544 
Odo n toid. Fracture, ol proceai of aiia, 5j 
Odoatoeaata. Follicular, of i 

(Edema, Parallel atody of bfeod- prea a uw , urine, aad, fai 
r.6a8 

ol idiopathir diTatafinn ol. 16; 
auigaqr ol. aad raapiratanr tract. 8t; 

Diffuae fihroayoaaa ol, caaaiaK dy^ihegfa aad death. 

Ill; Etiology ol caacer ol. aaa Homafh, 115 
Old age. Raiatfaa of arteffaaderaaia aad other 1 

Sa^ of , to devefapaaaat of epithalbl 

Oaaental, Caae of hifa, cjrel ia drfU. s$s 
Open treatment of fmctaiea by afaaafa device, 140 
Op era tiooa, Priaaary e c oaom Jc , oa wot, ygo 
Operative, treataaent lor thwntaaad lengiina of faoC, 37; 
Pre-, immunity with a t at b tica , $h 

I of , with f 



BMUdib,l< 




^atua alkaloida, Paripheial a cti ea 



y, C7; Acdoa of, oa dncta of toada, t77: 
oology of araler: actloa of, 4a6 
Oral, lyactinn ia lelatiea to qrabade i af i rtl aaa, 84; loi- 
far aaaialahriag aa, airway 
haab. a47 
, Moit HBcdcal pba for. 1 
tioa of the Mefial OAoera of the M« 
Coepe of the Uabad Slaftaa Army aad Navy, aad of 
the Madbd Oftcnnr Raaarva Gwpa of Uabad Siaam 
Aranr la mm* aad aar, 6ao 
Origla, Mdt»b au daamta wkh il i L aii la a aa to ba 
aatara aad. j86: aad coarm of 

OrthwBipUc raaacdoa of kaae artfcabdea. t44 

Orthopedbo h wraadoa b Hea tmtat of 1 

Hda, 40: auffery b war tiaae. 147: RIbef, aaqpry b 
early treataKat of injured and m i MMbit , 383 

Oithopadbt. l^aalBa paalyda-ib 



INTr.RNATlClN.\L ABSTRACT OF SURGERY 




,c 



Nvn. CtiM^lhwi of Naivdi uid RolMrt, sJi: 

of coBtnctcii, wHIi HMWTM iviffnKV to pwNOtoHQr, 
6ao 
ol «r> MvIb, GMttal raflcMO •'> -^Ic in pradactiM ol 

VH^ilOM arWiw b • K Uk£ or ifbboM, 

187: MaMfHMat ol lanor in mwiniiM ooaliacllaM 
o(. jei: DyvioctedMtolM, jm; Ckoadnanof. jI?; 
DialMfi for poi omiUum fai, ' ' 

. ..^ -, of. Mvk. Mlt of Mlipaiiil «iarai ia ouMlfaa of 

Aod, aynploaa, 64; iafoctiaa, 60: Vmmmi dfaaoM of, 

. diagBowd oad cwod. 106 ihoow ■winhfiBri. 176; lafectioM fai »oiwi, 

maam of. to kwMO. 173. RohIIo fioa ca- pallMlaiy with appHcatioa to tfaalaMat. 176; laflaaN 

actkaof. «o6; DcffOHidcyvl of.iacMM.s«J aartioa^ tTft; Kagaiwli aad aioaof aii nt of. afloctJoat 

■BlHlMiaa.«4 I iiiiliillt ptipiiarj . 41*; Ktia, caai of alwln 

' * ' ' of.Mft bM yi^^ 6* si la— ily aad, fliiMii ti ^immm , 

■oa of « aM 00 UMapoaUc avao* ^^i ^V^VV^^ pabb^ ioar>iacli Mpaialioa of poolffa* 

47; Kocaat oopakatattoao aHfc afciuai uridt rioa of fabdikr btaom Mpaialod boac, aiAyWi of 

ti o tib i. jm; Oaa-. Bu lB rid i ■■ao tt w l i. Moo^hc Mala. tf»i. 

i4 alliBai Midi aad.h oaifwy oad ohrtot- NaipfelpM, ludiaici of , aooaatonua, j04 

V^^^^#flM#^^^ ^P^j0#Mb#^aria J^ft^^M tf^ ^HM^^tf^A tfW AftMti^^^tfM 

, SSI I j6: woaadtof ocalarflQbt; dkoir tiaotawal laanagr. 

S44; TraataMat of, i^laifaa to oyobol. S44 
oa. of alpplt aad tu oua- Hah. Lobalar ipitfcrilBaMi of. 4*7 




_, . ... I of aMraaffy poiaiaias bjr ahootpcioa (loai va> 

PibM. Twa l aii t af woak lobar. Mti: AMoariail. s>« iIm* I74 

libor. <•. 6jo. lliiniMatVwriM ■rtllBd of, Fwnr caaNrj . UtrtJag Iholalwaal Maci aad^oo adlaacto 

■flhdN ilna. lAj ai tnaUaoat of oaidaoaai of v/hrm, aaj 

lclHt.i4 Pirfomdoa. Uloriat. with iMW of foniiB todhi kMo ab- 

ub i u ac al w Jaaaditr by. op rwa tioa. 99 doadbal cavity, 63; fai li-*^ '^ ' ^'~* -"^ 



lal cavtty, 6j; ia typhoid fivor —rtilarl with 

iaMoaoof.aadaaoa- acalo typhoid appoadkiy* hi cMU, 119; Aorta aad 

artary. 161; Pihaaiy caaoir of. jrt w di a cBto . of olaiiadi aad daodnMna, j6o; Chit la 

at of. of bladdv by M|h fiiawri vhirh it was paaMi t» lolav ntm^mBk^aify 

the whole ooam of ilnBiirti, 49i: R%kl ahdoalw- 
by balK; viMval Moaa; toaanloanr, ftt 
Saifial IfwtaMat of. olotr of tloaMMa, 114 
panic ainr. Its 

aodoM. Aaoailiai of hipalk anary; raplan 
; of lowar ofUvar, SM 

4i;Acaio PviafticalBr anoni eeoiploaliag Hpp 
lojM fadha* kaoo. sj __, 

■it: P lawl. hrawlliiai, 174* PwtiaVy caldiod r 
of. ngloa. im; aa«Ma ia labor, joa: 
iaiani ia oapHpiMe. aad lactal 
nlMBCi 10 ooMM. 470 
iof.aa|ci^jlM^ gnti<iM i^ OMM|iMtfc p ewor of. i;> ^ ^ 

sw *». ««i 



INDEX OF SUBJECT MATTER 



jQQil 



PcriumUlt, Fi«v«Bth« tiwttwt ol poftopc f aUve. a; 
wlt—M I gnaolk, t?: Moikni 
lof aoMt, 17; cawed by bik witlMut pcHom* 
' or UtopMMfB*. 1 1 1 ; Tubocttlooij 
in ywMC dMrM. tS7i luMBtgca rmy trmtnott of 

tVbOfCSlOMt ST* 

FakypkBUk. Oiigm aod oounc of chroak. 495 
Fwli'MCiJar •ynpothrticw. Omd aad oMHivo co»> 



Pfcanaamlngy. 



of 
of vas 



,608 



t77: of ureter, actioa ol opaoi alkafcihb. 4>6: 



of •HriMi twirtw, 
ilkaloidK. 436: ol 
54i;Coatributioo 



pffOttUtr. $41: of 

to. of ttovaiac, 61a 

EpithrKoma of pocterior. wall cuiad with 

ikctf e camiif if. 8j; pituitary; relation of aaaopbaryiu 

lo bypopbyw syttoa, 9j 
Phaiyafotooty. Opoativo twatmwit of soprdaryafeal 

pbaryateal ttaMNii by external, and ooneecntivc 

plastics. ii6 
raBBOMppaoMpnuaHM. oinoy 01 coaaHcai mooa nnnniaa 

ovipat aa as i a & ato r of opvativo ffak, 6j6 
PWniBiiBiiai. PathofMHii of. laatritii. iia. 57j: Soifi- 
cai ooMidentiaw of anrta ofoK, fMtritit, 573 

^^F^M ctiaaal waal t esta wfth 

Plqrmosicaij Shoes, and therapeutic. 41 ; Consideratioo of 

fraas standpoirt. of, suigery, 494; 

'a of haHedMnpy, 518 



Pftahaiy. FtMryMaal. lalatioa of nasopharyia to hypoph- 
yds qnleas, I5; Acanate radiography of, fbeaa and 



3J7; standardhation, 396; Use 
extract for inductioB of labor, 432; Bearing 00 
function of. body, 570: Experimental studies on rela- 
tion of, body to renal nmctjon, 610; Recent invcstiia- 
tions on Jnmimce of anterior lobe of, body ukI on 
properties of growth-oontiolliac constituent, tethdin. 



litru 



in in- 



Pituitrin in post-abortion cnmllaassBt, 67; 

tration of, to mother peoduoe nervous 

fants. 183 
Plaoenu. rwh in t uia tad . 633 
Placenu previa. Cnssrian section in, 300 
Placental, Foetal and, synhilis, 187 
Plaintifl, Burden of proof on, sos 
naaucs. apnmrt er, m moomiMnna aivi. joo; usteo', 
of prriosls—, vfii Pisa for icaaissance in, 
r, 4t.i ; Faadal, in tiaunmtir chib-fooc. 50a; 



_ n i p ni e witn, ope ra tion upon breast. S7*i 
Todarfqpe of vaginal, qpa rat ion for cysto-rectoosia 



and p rM M se of uterus, 625; reparation of laryngeal* 
tncbsal diefects, 64^ 

Pleura. Suppurations of lung and. with surgical Indica- 
tions. 13 

Pkunl, Treatment of. fistdB. 358 
war wuana 

BtaSL. 



of stoasadi, 397 

Roent^n camination as aid in dHhrcntial 
> beCwesa, and enpyemn In chldiun, 51 7 
Pnsumothorsa. UMamta reaulu In lisafsal by artificial, 
no; Iml l rat i o na and isadu of artUdal. In 
of pdasonary tnbwcnhMis. ssss 

tubaRukais of hnms, »%$; Various (actors of 
tioa te persona with, 359 



PodaHc t H r tf*4*t t. Luaibar punctues of iotas, durii^, la 
: of lis of tetua, 18s 

Orth epwilc ob asr^n tioa h twanaaal <l 
wirB*aw«> 40> siacaaaiGal aad MiBcal liHtoMBl of 
talpaa das to aalarier. r45i PoslisbiSa tantiMaC of 
aatarior, s66; Treatment 01 paralyris Mbwing. jlo; 
Aalsrior, with rfffi tn < T to priaaplss of tnattosat 
aad t heir prac tical ap plication, 380; Opa mtl v a twat* 
aMat of ,380; Prevsatioa and cunaclloa of osfonMijr 
ia, 380; TlcataHat of paiahrais felowiag acaMu ili; 
Bnaataasaoaa iavasioa of oseshiUMBHl aisi la* 
3**I Ointfil n^ftrTTatiftM na iBagawis aad trcatascak 
of. at Wmard Parfcar Bospitol. S9a 

Polycystic CBaical dato of, Udacy. 4«S 

Polycythcada. EakofBver In acute^ furt her shss nr atieaa 
on effect of shuttiag off arterial blood supply to Bvars 
reaction of aoraipl aafaaal to epiaapMa Md naoval 
of liver from dtadatiaa. S97 

Postfebrile treatment of aatorior poHoamtli. a66 

Postmortem aeaareaa sactioa, 539; Caas of so<alled ab- 
donunal pregnancy with. 6a8 

Postnatal. Picnalal aad. care. 432 

Postoperative. Preventive treatment of, peritonitis. 2; 
ventral hemis; study of hernia foUowiag soolapnro^ 
omics, 112; X-ray treatment in maM g n a nt growths. 
160; Prevention of. gas pains. 346; rnaiplirstiBas of 
Lane short drcuit and oolectoaqr. 367; Canmfion 
and treatm ent of i dlnpalMr. oya rati v. and , anoructal 
luemonhage. 497; hMaalaaMHa aa a rssult of cklor^ 
form naroosM, 5^ 

* ostoartttm sepsis, ^o^ 

Posture. Conditions sffecting. 39: in shdntninal drainsyr, 
101; in obstetrics. 304. 6jo; and types of breathmg 
exer c ises , 384 

PostnrsI, prophylaxis in relation to drforadty. a<8 

Potassium iodide. Absorption of. by thyroid glMd ia vi««, 
following iu intra vuBOus faMscnoa^ss 

Pott's disease. Trentassat of. by Bbb's awthod. 147; 
Radiographic sjra^itaaHof. 38$ 

Practitioners. I m port na c s of gettiaf modicnl, and ^d> 
to c»«pomte with locJ hsalth aathorUsa. 



534 



Piecan cer eu s deramloses, . 

Ectopic, which had gone bsroad fuD time. 66; 
aistakesinr 



.. .4 ^ 
Pregnancy, E ct opic, which hnd i_ 

" _ osisofectapfe.627:AbdQnrfMl. 
66; Case of so-called shdnaiiBal. with postamrtcm 
report. 628: and arterial tension, 67; Adoosis b nor> 
mal uterine, 180; Ectopic 
uterine, igg; Tubal extra- uterine, at fnl 
rupture of tube. 290; Ileus 
181; Tubcrnksts ol hidney during, tSa:'at lara ia 
bn 'urn at e bicarvical uterus. 183! Lsu co cy tos in. lahar 
and puerperium, jfoo; B i o l n ri c diaaosis of. joa; 
Drainage lor pus conditions In pelvis durhH. 408; 
~ ' c) ams^ of. with typkai 

•sa aad 





olv nrmNATIONAL ABSTRACT OP SURGERY 

4«*. sj»; K«*4 tw ii^ 





I 



■Ml 7, Itl 

rfMlknih, TMy, of riniillil oiklB, itd: oIlMi 
tiwiid b)r CMial OMOM gull vilt a pirn of Ibd* 



' CtSL TViift far, tr; iHBim ol mriM tnu- 
mmnmt itj 



inw MM iidt. |M 

jm; Ploili»SialfaiMd,«ludMgr, iM 



,. , , . 419; Timl- 

fli ftwrtiit pdvM wilk iptcfal iifanMi to. 
6so 

• fai iwpwfjr, kber. aad, joo 

. , flf. eoavvWoM, M; «ckaHiiii, ito; 

fllmw Itlw. 1I4 



SIM ■■HBHi «i aaonMqr ■ aaMM poiqFBi^ ^apww « m ii—iiw. i«« 

il MMHb iMt «l pMNMnrivt IM pilHb lA PwKHMiy. Bstaafaaml Iboneoafatty iai. tabMoteli 
oMMriM •fhhrirfly' to |i iiMy m 557 IK 1*: EstncdMi of lotm-. pfo|octto wiUi loiap 

of 4kaUKKf fdboioa fmctoM of ot cakk. fo«: oadw ki o w . tj; Trmumatk. t o l w wo li M fa. tj; In 

md itnttMOl of vow in( uowtfat doriot P**!* «tlfiHnoo tad iomiIu of oitiidtl MooaodKini fa 

Sjo; cfaraaic iMdtooir Mp- tfootaMOl of, tmbmatotl^ 155; AppwdkMi •a' 

tuMRoliMMi sMi Topflniopliy of, Moofoi oad 
fai lolioli witfc wfawco >o thiiiiroaloili. 4|| 
""aod-pi— III! with irfwMcii to dh 

^ilMMwolir oolictkMM of, aad pi dot to pl- 
lat; DniMti far, g o nditfao o fa pclvfa dwtai 
toorio onodoiod witk pnpMacjr, 40B 

SM PyriUft of fafucr; aodt of Infwiho, 71 

tod. fa tnolMM of l^riapM^. Eiieu of loloMfao fa Udacy oi oMdto 
oapbyodfa. S9 
I fa fanofai ili^ Old tsnlam. 40^ Pyfaroi» Kidicol con of foaci^ of. sj. BKnafaa of. bjr 



of falapfaMMfjr. «Wb farom fa l wi t o i hMi of taran fa oaloric Immb, itft; 

NaM7 crtacte of «o^ i^; _ ^ of o^ob of noalpaliMnipsr fa tpoMi of, nt 



Paol^Md. TocLfaM lor lOHeifaa of. lodani. *6: ipfan r\\ 
«llktoafa«ofpodkfafartMomllM.ijo V 

HiH^liili of fnip«ol coavdriooo, fltT^^tfani. fa 
iJiilM to difanokjr. a6t; oad Iff— I of port* 

OOOOdWtfclll«i l h M .47J P/ 



of Uoid^oMH^ fw P>hde,___ ^, , ^^^ .. -. . ,__ . -, ^ 

far, cadoMoOi. tsS; 
Mai, j6a: Raoaupa 
fa poM-. oloM. S77; 

>4»7 
lUAWTITA TIVE ■■■ failtna. Vafao of. of iMmbIj iJ 



,47j DACHIDIAN caaol, LavoM aad oaHMnfa of, fa __ 

Pimfalfaiih. Piwmoiiin oad. vacdaatfaa fa onfalth of ■> aalfc aMafagWi, ui Bfaapad fadfal awvabfa fa 
fafaato. »(|t; Vafa* of. ra;>fat oftor opwatfaa far caa- faMrior of. ottaciod fnaa oiidM of a««oi of Iko 



4«»: opWoiavr. sm RmmvoI of taail Oi, MHoon. jidi ■ ■■ fa fcaaMag S^iMtid mmtkm ojfat y 

MotOy KaaadoiaiwaM OL Mc Mfattaa ol* puM aad opMaitaa. loj oadoaMaal opHatfoa tar CBidaoHa off 

toadaal vomcmo to afCfamani Aoa* TwaisMM bjr oi^ds atHi. 169} caatMy oaontfaa fa faoail caMB^ 



. _ ^, kjr cordi atari, 169; , 

of caicfaoaa of, aad ofadHr. joo: Hypor om, t«4; ortJipatfaa of faa w yaad mc, 514; 

of. 4^; I'kanBanfaijr of, S4i; OMniclivt opo foM oa. S4S 

m^$i» Bodfam. EUofacr oad twotaiit of 

with rcfcrcoco to oH of . to; UootaMat of 



o«», 61: Etfafagy aad mataHM of OMBklkihrfe p^ 
tv, aM of . to? rCuMM padMfa faMfad oMiiaM^M 
or.tayo. i6t;TVMlaMtb)r,of CBRfaoaaof pooilBto 

ii6i Ronlta oKiMbsrwoof. fa twof i of caa- 
ow of alM«i. 4m: fa gjraocnfaDr, 4t I : fa UootaMat off 
aot fa«Mr47«rPiifad«o inatMBt off 



— , 1 of cwu ajr Mooat of. 6n 

w a dw ^tiopa. Oac. oa oar pfatt. tai 

) of FBtt^ dlMOM, jts: 

SIS 



INDEX OF SUBJECT MATTER 



xsv 



R xlfa py ^^ ci jpJHjtddir, i »6; Aecante, of 



pituiury 



AdMKigic. •nqjr M iMwiiMi oMUucdon* >j; 

of ginoiH piniMi. 57; EvohitM and tiwtmaDt ol 
iaitct^d nwioM ktliam, tbtJIm by. e«min>Hcwi. 616 
Radialaijr. lUnU* of •■ po ri wi co ia mu, 161 
lUMttothnipgr. TMUaMBl of Mow of aervv-tnnits bgr, 
of Mtvo dcalrioao, J99; of fatw ihrinwiMi aooplMao 
oltatkahr orida, s^ J 
ladlait Pkaem 01 kmcr cxtramity or boae of. sS? 
Kat, S^oMMMOw toMn of . sgS 
Raactioaft, Tiapwahiro. in uuphytexit, $4; llochaaina 
of Mnnmtei 

!*• dfaoaio^A a oBMpJy aad* i$t 

forraHclMNiof profauNodt s6i C o ijcct of, 

Racul. aii«lk«ia, loj; o p wa tloM naifar local aaMlk«k, 

lasi Todnkal (catuno fai ■aprapohic. periaeal mad. 

opotatka with rifiraaca to oip ow u a,47o; r%. vagiaal 

oamiaatioo io labor, 6J9 
Roctocde, Study of aaatoa^r, pathokcy. and treatmeot 

of uterine prolapM, aad qrrtooele. 6aj 
RactovHiMl, Molbod lor doiiag lar|e, fistube, 174; 

AdnovyoBM of . wpm, (a4 
RttofMfcil. C y al o c o p k , tyanrflhiminatioo. loo 
Radacti o n . Inpoftaaoe of caily. of fnctnra with dlqiboe- 

BcaL, 141 
Rafltw. Genital, and their rAte in production of tymptoms 

aiimK in pdvis, 175 
RagMManoa, Roconttitutioo of two-thirdt of humerut bv 

itanlo perioatcal. 38; of bone in its rdatioa to culti- 

vattooof ^ 



.383 

a, Inrrrating OKftdncv of nerve-block- 
lag or. a; Gj'woological aad obatetrical operatioot 
under. 198 

changea ia bnaat, 4S1 

of blood from thoradc and abdominal cavities 
aflar severe luemorfbagm, ^3 
Rslawad. Correctko of. abdominal wall with reference to 

OK of buried sflver chain. 1 1 1 
Renal, Results of operatioos pcactioed for c iU ac U oo of, 
calciili with rcferowe to nephrolithotoaqr, aaa: Com- 
parmtive study of tmte for, ftactfoo: fkm Bmmfkton t- 

Hood: Aabard Voodfideat of urea OKWtio a aad tm 
meal for renal fuact ioa. 7a; Value of Ambaid quotient 
la —*—»*"'' of, fuB C ti o B , 189; Experimental studies 
oo relation of pituitary body to, (unction, 6to; Func- 
tloaal, tests wtth Kiecial nfn fn n to significance of 
iBBaiflMH escvetsoo of Dataaida aao laoisO'^arflBiAa 
189; tubeicaloria, 306; Etfology aad pauology of 



Rmplffatina, Various hctois of. in persons with 
thorax, jj9 

I msalal sladyofaw ofi. 
> boom fraait pamagM* j6; Ei 
of awphag u a aad. tiact. St 






itoatadjrof I 



Raaalta. UWmala.la twatmif by aitlfidal t 
no; of a ipwiWMa ia war ndiology, i6i; of 

treatomat of owplrthahate goilar. >sj; la 

aad. of artUkial pacamotboras ia ticatmeat of pal- 
moaaiy tabeiailosis, 355; of myoaMCtoanr, S96; ob- 
taiaed by use of radium in trcatmcat of caaoer of 
uterus, 40J; from our present views rcaanfiag sadft- 
crinal action of ovary, 406; Healiag aadaad-, ia scar 
of transvcTM (nndaa i a ri iio aa ia Fritseh caaaraaa 
•■ctioa. 4ia: of opm a ri oa a practkad far csbactioa of 
reaal calculi with nfHaaoa to acphroKthoCoanr, 444; 
Late, of nashoC wmadi of head, 474; aad tcdMiqae 
of vagiaal siAlotal Imlmactoaqr for proddcatia aad 
cYsto-rectocele a s soda te d with fibroid growths or 
fibrosis uteri. 524; obtained ia kvage of reaal pMi 
within past ten >-ears, 536; in treatment of (rsctnica 
of neck of (emur. 589; Bencikial. of prenatal work, 63s 

Retentions, Treatment of, hi abortioaa. 414 

Retrodeviation, Uterine. 17a 

Retro- and downward. Opmatioa far, dJip l ncr mea ts of 
utcras, SM • 

RctraDeritoacai rupture of du od ewam by blunt fom. 493 

Rhaboomyoma of prostate, 76 

Rhinostomy. Dacryocysto-, 641 

r, of owkal region, 350 



Ribs, SapamBoanr. of owkal region. 1 
RoentgMOgiaphv of BMMtoid, 315 
Robert pdivaa. Cawation of^^P* aad . ^ 
Rocalgea. IVeataieat of aopHaafaafe gonar by 
oTreys, ti: Value of, my swimhrnrinaa ia dim 



caaoer of stomach, at : PMrnat atatas of, ttaapy. 57* 
Causes of error in. rliagnnals of boae aiMi Jatet oaa> 
ditioas. 58; ny treatment of exophthalmk goiter. 
107; dkgnosis of lumbosacral recioo. 147; my and 
its use in surgical diagnosb, 161; Value of prc-opera- 
tive, treatment of cancer, i6i; Cancer patients treated 
with, or radium rays and remaining Hinirany cared 
after more than tluee years, 16a; my thcrHNatka. 



a8o: Riolnrical cflect of. mys oa arioa, s8o: dagaorii 
of<fa>daMaatar.4g3;gMaiaatfaaaaaldlallfiiir 
tial di a gan a fa b at a wa paeoamak aad oavyaam la 



acute, lahctfoa ia pnpNaqr aad p i MtiiariM Bi. 418; 
Result* oblalBod ia lavage of, pahrk withia paat taa 
yaais. S3^i F*^Tw!Tfl ^iffl of haamalhidtaaMnuBlM 
(arotropine) as aa lades of. fuactioa. 608 
mrcbes, ExpariiMalal. coaoeraiBg hjrpophvria of nag* 
53; Stud/ aad, oa Beoctal regka. lai; Inftwaw of 
modem tmaamitv, oa io^geiy, 516; Cttaikal coarse of 
r in light of caao«, ggH 

Terhainaa lor. of piaiapsad lartaai. s6; Coloa. 

lb Iwttcadoaa. ia4; Orthoaonyc, of kaae artio- 

I. iMt madow. of laiyas lor removal of i»- 

mangiawtf dtaaaaa. 108: Segmental, far gastric 

491; oaa haadfod aad mmf-tix opa r atioaa for 

fc stooHch lioan alBlyoflaiii. 573; Ttaaamtic. 

of cast to aa to p ealpoa a or avoid ass of 
r.634 



children. 517; Sarcoma and. rays. 518: ray fiiafiaal 
of tuberculous peritonitis. 57a: Some liiiiitsriaaa 
in. ray evidaace of gHtTO'btotina] lesions. ^73; ia> 
dicatioos far sargkal procedure in ponpyionc uker. 
377 
Roaatgcaogiams, of chest ia tttbcreakaiii s8i Dcvioa for 
ofiifaiiifeg ktcral. of spiae ia ^jrparsftaadna. 518 
' r. te kcalfaatfaa oTbiala taai ' 
hI eoancaliva caam. i$$; 
1 of. of athmcid aad iphaapld oaliw 43> 
Roaatgaaofa^cal. Evaatmtioa aad harak tfaplMH 

iioa^ vNwpoaK oamamo irom casm maBBBssa whb 
X-ray. tt; Premaoa af, 
•abdahoid * T t ^!* tu $$; Fka far 
BMBt of dosed Ikaclana faaai, g 
of itoamch; a rMalral aad, Mady 
twcaty-thrm caaas, teS; Iwatmaat of sja 
' oChar taawn of fao*. 6ts 
, CaiB ia «ydi it was poaaM* to 
I gf atoaaack perforatioa. aas 
Roentgaaaiogy. Vaa of Ikariaai la aaalegy aad, i4t 

^"^^Ttsz'i^^^smsiL i sssz fa 

soo; w ai aeo m acuoa m. m apaam m pymsas, 57a 



l8i 



nvi 



INTERNATIONAL ABSTRACT OK St'RGKRY 



r. It?; «f 






SACCOU •! Imp iMMtea «iik iiMdAl ralmwa to 
llMli wlHiiMtotliii Ill <i fowd iwM. sit 




stSLrr!iSuiJ!rci.d 

otiscitd ffOM mMm oI Mivn of cmdft Mirfnt ffft 
wld. S u pwloc it y of rkhl ridt mms fai laadft^ of 
pofttal aad eeaohli oMnKtiMi of lo«or ooloa aw) 

n COMB OHONM Mr HMWM OpHMMS, MJ 

piMty MC MM of ( ooMractJoo, ^Bo 



t:ol loag k hrfbM, m; mmmt of Mjnn-, tMoMd by 
X^ «}: GteMi; of hafa. ayo: DMoMm oI 





- «»S 
flMdol MM li la, ||t ^ _^_ 

of MMMHI OI^MMIMI Mf MHH|^> 

olk« BifirtlDiH. 99; TwilMMl of Mttil 
knr. dlMMt. So; DooU* Cft« 

of OMllcoi pMMft 

M*: FMr 

of. fllMlOli M MM. S^. 
MMl MKtiOM. «4I 
of OMMMUty. to 

for rriid of duoak f raoul. 

» cored by X-(my». 4i; Vdtir aod daofrr of 
ta di^Mrib of dMow of. awl 
biMM. tsi; auHM CMod by X-rmyR. tri; Etkior' 
idit of Kor Umm i«. cMC Br. ce6 ,^ _ 

ipoBBoraCic OBVBfMS of lof|v. d rficto witli hors 
106 
ingoift Mid hoofiww Mtwv ia fmh InctorM; Albw 
toOMiqw. 16 
War mMMt traatod by. sio 
dtiatt, Importonre of ptoprr doMM of. fai blood 
tSMMfwioo. joj; ApfMuatM for trnMrniaa of Uood 
by. MMbod. 474 
SoWHo'.foM. ttb, tWuMM of ooavolMMBl, by phyrical 

?fpOMi. Mothodof actieaof iiiiiUMlbwip^ »■ of i»vio*m- 

SpOCWC MfVM UOOtMMt of OWMdi. 44 

9|wnMlnooo. Fcrtllly aad atorMly: mimI) of. «vaho». 
MdMorfMMid vogfaMl MCMtioo* ia idatkM tolldi 

S|dMSoSlcik!'obUqiir BMlbod of riiiaMii«i<wpl|| of 
IS7; tilMHid and. 4JI 

fod. iQo Spboaoid iImm; pnanCnlay vahw of Mmkal 
41! 



TMlaM|Mi of « on d iwallo a for 

J9i AccBMto la d lniwiMy 



to bnaaliiMtli aM. 166 
dMir. PloMd. to tnaiMMl of 



TTpiai. 



trt'.Coaoptivt 
of. 410 



_ O! 

of ofMia of draii M Inodk. 4»s 
of Mdi and. y : bmn for n 
Ub aad for ottM RMpoMi, J 

of. h^lMMMd adda-loiM!!^: Dovfai for 

MMtpMfMMa of. 



5«; 



«f. 594 



INDEX OF SUBJECT MATTER 






J5>; AM lMnrfc i f ^ l ucum m thirty, 
ioiuffim. Hio: Cw t otcopy m ith ga wtk aid in. 
■i«c». jo8; InjuriM to. ooid produoMl liy 
• arfaic, jiu; cord neophami. «8s; tumor. 
i&S. lajuriM o(. cord ia war. 504; Poiiibw functJoaa 
of cciabfo-, ittid. 505; Tumon of, cord. Si9y, Oiitarb* 

aacc of bladder f lliw aftar giMhnr uUorkt of. 

coed. 6j5 



ia ralatioaAlup to panidodi aaHsiat ttltuic 
■ia. aad kMBoivtic Jandiot. ji; PraliBnd. villi 
ioo of pftMt lor tea n K«fnKf _ ijo; sacoiiifnl 



I of. for trauoaatic nnttu* c owi|i l fc'at»d by trau- 
■Mtic ialcatiaal partsit, malaria, aad hookworm, 4Q9i 
Baaction of. io acute iafcctioot. 4oq; lotraparenchy- 
matnni hcmorrhafe of. (81 ; Blood chaoget ia albino 
lata f dtawi ag maoval of, 611 

Bplwctoty, in ^dmJc aaraia, hBowlytk icterus, and 
Haaot's cirthwii, 1 jo; In pwnic iona amemia; studim 
on bona-nMtfimr ■rimwatfam, tji; Pemidoua awnaia 
treated by. and ayrtwnatic, oiftcn-repeated ttaMfndon 
of blood. tnuMforion in benxol poitoniiy. ijr; for 
hsmalytic jaundice, 133; Late results of. io pemi- 
dow anKmta. ijj: Blood-fat before and after, 154; 
Aomdred hKmol>-tic jaundice with. 134; Value of. 
b OMaaw of blood, sfli ; Occurrence of nuclear chaocea 
in red hloodkalb foOowiiv. 607 

Splenic. ComnHfation arising in treatment of. enbufe- 
ment wita thorium-X, ja 

Splint. N'ew, for fractured humerus, 247 

Spondylitis, Local i«d osteo-. 33 

Spontaneous, rv-olutioo in trans>'crM proentatioo, 302; 
tumors of rat, 598; Primary, sarcooaa in mice. 600 

Standardtiatioo. Pituitary. tQ6 

Staphylococcus aureus. Production of kidney lesions with. 
tosiBa,u6 

Stada, lataannal. and its treatment. 1 19; Intestinal, 260; 
Chronic intestinal. 364 

StaH H ica of 1.000 war operations, 400 

Stcnoais. Congenital pyloric, at; Operative treatment of 
sopralaryngeal pluuyn^eal. by external pharvnyotomy 
aiM consecutive plastics, 316; Benign pylorK. and 
iu managrmmt. 363; Treatment of tracheal. 4&1; 
Post-tiaMMUic, of femoral artery, symptomatology 
of which led to diagnoais of ancnnsm 513; Pyloric m, 
infancy. 576 

Sterility, Krrtflity and. study of spermatoaoa, ovaries, 
mod uterine aad vaginal tecretioaain relation to. 177 

Sterilixatioo. Siaaple, of women by cauter>- stricture at 
intrauterine tubal openings, compared with other 
ntethods, 6( 

Stillbirth, Foetal infection as cause of, and sundr>' obstetric 
theories, 629 

Stitch, Treatment of. suppuration, s6k 

Stomarh. Value of roentgen-ray examinations in diagnoiis 
of cancer of. 21; Saienr of, and intestines, tr, Opeia- 
tivc treatment of multtple callous ulcers of. 1 it; Sor* 
gical treatment of perforated ulcer of. 1 14; Etiotogy of 
cancer of <wnphagus and. 115; Value of quantitative 
diwinalion of dissolved albumin in gastric cootania ia 
diagnnais of cancer of. 115; Massive hniiaunli a | H 
from, without d euK— tr e b l e ulcer, 257; Method for 
obtahdng ooapiala aaepab at, and bowel operationa. 
as;; TreataMt of duooic ukar of. a$8; Acule and 

route. 361; bubdiapluMmatic section of pncumogaa- 
trics io some dlirases of, 197; Support of, after B^rea 
■Mtropexy. 490; Is ea^ii^ymcnt of actual cautery 
Si treatment of chronic wer of, safe procedure, ^1; 
Case in which it was possible to follow rutinlgpnuigg- 




icallv the whole cawaa ol, perfomtiaa, api; Oi 
drtd and eighiy-dx operationa for diwinir, 
utility of laiic resections, S75; Adenoma (ormation 
ia, of rabbiu Iw feedb« with lanolin. 608, .S>phiUa of. 
a clinical and toiiBlgwinlngicil study with report 
of twenty-three casea, 60S 

Sto— B, Removal of, from kidney, sss 

Stovaine. Arterial contractility and. in mMwctton with 
blood-transfusion, 47; Contribution to 
of. 61a 

Strangulated. Volvulus with, intcrtina: 

nmphaln wntericus. 24; diaphragnmtic nentta, 32 

Streptococcus infection as cause of abortion, 531 

Strcptooood, Claasification of, 53 

Stricture of ureter, 73; Organic, of urethra, 539; of urethra 
from extra-uretnal cauaes. S40 

Stufl^ia, Weight-bearing aaaputattoa, 39 

S u bacwnaial bursitis. 500 

Subcutaneous adminirtration of fresh homaa blood. «o6 

Subddtoid. Presence of roentgenological s hadows aaooat* 
ed with, bursitis. 33 

SubdiaphrsKinatic. collections of pus and gaU due to gall* 
stones, 1 28; section of lanuiiMHistihiTn soase diMam 
of stomach. 397 

Subphrenic abscess. 135 

Subperitosteal. Removal of. bone fragments in primary 
treatment of artSlery wounds, 142 

Subtotal thyroidectomy. 108 

Supcrfirution. Does, occur in humaa, 185 

Superior strait, Forceps in, 421 

Supemu merer)' . Two cases of. ribs of cervical region. 250 

Suppurations, of lung and pleura with surgical inmcaticns. 
13; Technical and therapeutic encrience in ultraviolet 
lisht treatment of. aitd tuberculosis. 518; PrevcBtioa 
of chronic middle-ear. 545; Treatment of stitch. 563 

Suppurative, Prevention of fecal fistula in. a ppendi c ft ilL 
36; Periarticular abscess complicating, arthritia of 
knee, 35, mastoiditis, 315 

Suprapubic. Technical features in. perineal and rectal 
operations with refereixx to exposure. 470; prostatec* 
tomy under kxal anesthesia. 543 

Suprarenal hemorrhages; their S3rmpUxaatology; difficulty 
of diagnosis. 424 

Surgery. Induced leucocytoaia as an aid to. 45 ; of theaflML 
245; of gall-bladder. «7o: during and for complicalaa 
pregnancy, labor, and n u ec a rri aa e; standarditation of 
surgeon, 419; Central-eyed needle in, 565; Industrial 
medicine aeid. 621 

Surgical, aspects of infantile paralysis, 267; Value of blood* 
pressure observations oaade during, Mocedures, 272; 
Sphenoid sinus; present-day %-aluc of, procedure, aji 
Fncal infections m ralatiaa to feaeral, ooaditiona. tt4j 

S u K e pt ib i li ^of man to fordgn proteins. 387 

Su^MSHion. kCsum^ of year's work with, h ry agoecopy, 8a 

Suture, Lung, at front. 15; Bbdder. 73: of heart. 256; 
Bactcriologic control as an indicat ion of, of war 
wounds, 285; Prinmry immediate, of war wouadk 
286; Use of secondary. 56(: Osseous, with chroaddnd 
catgut, 591 ; Tendon repatf without actual, SQi 

Symphysb p«d>b; four-inch separation with pr o tr udo n of 
bladder between separaii il liiaw antylnds of ma^ 
iUac Jofato; faBure of pos tuirf a ad w ^y irt i w ■to;' 
auiea; icrtnration of pelvic giidh by wiriiig tluwipl 
obturator foraiMa. 63' 

Symploaw and phydcal sfgna reaoitiag from wouadi of 
chest. 253 

SyphOa. of body of uterus, 171; Foetal and olaocntal. 187: 
Teelicalar. 308: of the stoeaach; a dUical and rocnt- 
ginnlngirel study with report of twenty-thrsa cana, 
608 



IKTERNATIONAL ABSTRACT OF SURGERY 








^ j,f76; R< 

dijrraid glud. J97; dWcal 
m, 479; Actli>« 01 
•ad hioctioD. 479; 



of. 



la, te 



tioa of, gbad, ^79; abiOMi; twa aaw ilpi of tldt 
coa dM oa. 571; X-my» ia diapMrii aad tnalaHaC of. 
aad ttnrani olHBnMBt. 6it 



of yood; Aadbud^ rniJrlill of 
lal any lor loaal faartlnii. jr. of 

lytic, ipo 



_ _--^ — __^ 61s 

■■B Ta jTwiBOCftoay t Sawotal, loB 

oa* Tua, PMadarttnali of. tnattd by 



gmft 



ol. tyyj 



"tailo. tmoaadid^j^Aciloa of opinm •UAjoldt oa 



■St; la cMd and by 

IS7: Pru o aUu a of. t66; 



with phot of ibda froai Mat rido, M 

TIbiaL DHadartbiwii of coapaital ofj^ sM; Four 

Mob of liiMW giofliii Ipr towaof. oabitaacoi. s^<; 

of potlMOf • oftofy aad vna. 

act of baclMk aad baaua. 

m aadMpiki. s>s; 0" f^. 

iaioM lor cuati ol of Mtodha ia taaiHoctaanr, 547* 

Mtoaiatf>aikBl«aaBdi.*7Jrri^koBiaHaiof.byaBti' oifMi riMdd bo ala of «HiMa, 515: fngiiMBia aad 

MfeMrfe Miaai ia aaafca aad lOMalod doMs, jq6: « 

Aia Umo bacBat curiH*. m6: Coayonitbo vaiuo Tooi, 

- ' — M. i;aacar 01. aaa floor 01 awMM. los: umiaoi _ 

of 



"£', 



of. topi iwboicoioHi of. 199! 
■ ^ • of. ^76 

of luag Mbwiag opwaUoa jaa, aad 
45»: 




bf yrfi BiliMd. is« 



cyMNM.aD^9piMcafM««vlaraiofMMAcdoa of laniiiifil^ diiyja»<kj 

of, wiik ahnM lonaailoa, >i; Acala iafodioai pro* Ttecbaobraacbial diptehoria, 10; 

«p«M.dhM%4l« baadi.j6j 



INDEX OF SUBJECT MATTER 



Bdi 



Aftcfkl coBtiactSty Mid HovBiM is ( 
Ika with blood-. 47; Pviddaw awBafe tiwtad bgr 
•ad ■ymn—tk. often icpmted, of blood, 
fai bmol pdMBfaw, 131; New method of 
154; Diiwt. of blood, IS4: Blood ostnict 
oMffnlaoU and blood. J9«; Unptoa- Brown method of 
blood-, jgi; Appnfstue for dinct «id contimiom, of 
blood, J91; Blood-, with MiaftMonlod 
01 p wmec doMi 



tnbei, 3i9i\ Impoitnace of prapet doMce of 
dtimte ui blood, sni Coaeidention of recent methodi 
of, with indicatiooe and technique, M4; Apparatue (or, 
of blood by eodhim dtiate mraioa, 474; Blood-, 
; dedactioae (ram ainrtwin caeee; devea 
and ei^ on dog. 3/67 

, CjtlOMOpic icctovceical, 190 

leractomy. iS 

, ol boiN in fmctttfce, 38; of articular end 

epfphyeeal caitfbfe Une, j8; Ex- 

perinwotal inveedfatioae retardint (iw, of periphera 

43; of thyndd gland in dagi, 51; Ovarian, 64; 




Geaerel prindpleeobeenred in bone, 145; of nerve, 149; 
New emcriments on oncstion of homoplaetic, capacity 
of enlpVjfeeal and jomt cartibce, aM; Experimental 
■tador of artirpatioB and, of thymus, 275; of abductor 
hateietiBdM in eaiiical treatawat (or hallnx vakoi, 

279; Neworimtioo by mcaaa of iaaervated mnicalar, 
ito paralyMd mnede in (adal paralyrit, s68 
Tkaanlanted. Tniiariptinw on hemfltarv trammimion 
of dlfleicacee la wMCgpribfltty to growth of, tnmort in 
various strains of mice, 51 
TVansvcTK, Fractures of, processes of vcrtebne. 368; 

Spontaneous evolution in, pres en ta t ioBL 502 
Trsuma, of aedc and spine. 7; lorn blood- pwewies not 
issorletffiil with, or hcmorrfaage, 391; Late effect of 
brain, 478 
Tkanmatic, pulmonary tuberculosis, 13; surgery of liver, 
ia6; asphyxia. 15a; aneurism of temporal arterv, 156; 
Lavage and antiicpsis of rachidian canal in, meningitis. 
355; ksions of posterior lobe of hypophysb; typical 
FneUich syndroose; d iabetes inajpims. 3 5 j ; cauM ti o n 
of aptrfadiHtH. 49^: Soooesrfnl okImw of Bieen rar, 
by tiamatic lalertiBBl paicda, 
ho ok worm, 499; aMariMM» ^; Spon- 



I 



taneons, ureterorectal 

tkm, $36; resection of hip lor war tajaries, 591; 
aneoriam of left femoral artery: extirpation of aac, 603 
Treatment, Dry. of wounds. 24s 
TrBpaaoMBCtnre of bteral ventricle in prolooged form of 

aaanifoooocic cerebrospinal meningitis, 249 
TlicMor-tartiarybtt^ alcohol aiumhr aa . 153 
TrisnwM. Tetanus foUowiag servm fa^ieeDoo particulariy 

ffj*"* without. 156 
Tkophiam. Waller's law and theory of, of aervca, S69 
Tnnk prrsentation. Clinical noU of wwddlral, jos 
T ttb e na h w ia. EH i ap k ui al thoracoplM^ ia p ul mo na i y, i «; 
Tiaamaticpaiaiaaafy. 13; R oamg siw gm msof chest in, 
SS; E x per im e nt al bone. 139: ExperliMntal iBv«Btiga> 
tions in Rfard to entrance of in f e ct ioa aad owde of 
SMMMHag m, of female generativa OffMi, 177; of 
IddMr daring pragaaacv, 182; T iwl ia i a t of teaitaL 
fai mde. 193; Urogenital, 63^; of ep h M dynil s treatad 
by Durante • method. 194; Priamry, of eye. 195; of 
coiUonctiva. 314; Plea (or iJectr o c a ut e r y hi treatmeat 
of bryagml, 198; of tongue, 190; Extrapleuial 
pMoaothofas aa laethod of choica in treatmeat of 
adhereat cavaraooa, of hmgi, 155; ImHfatinn s aad 
remdts of artifkial paomaffrhwaa hi treatmmrt of 
pdMoaanr. 25$: Rend. J06; TkcatiMBtof aMilaLAit; 
Aapitlcllh and pulmonary, j66; FhttI inMSiiatt 
ia boas, 373; BiUteral. of bnait, 481; of nmiMaiy 



peutic 



481; often of taooadary iflaportaaoe to ntlwr 
513; Technical aad Ihna* 



ia ultraviolet Hght 



s ti p p Miari eaa, aad 518; TrcataMat of vactsbiaL ns 
Tttbiecmar, Etioliagy aad pathology of aoa>, laaal hm^ 



'£ 



lioaa, 306; adnexitia, 40S 

T^dMKidoas, Acute. peiitiMUtia; peritoanl 
pentBaitia ia jrovag cafldMa. ss7t UHfla 
kpericaiditk with egiafaa; arti fckl 
pericardium and hydropneaawpericaiahHa, 
Roentgen ray treatment of. peiitoaitia. S7s 

Tubes. Uterus and, contained in iaairfaal nnaia ia 
18; Method of fixation of infubatioa. 81; 
of men et n i a l redas thnmgh, 408 

Tubal. Simpla Ustihirina of wonMa by cautery lUiifw 
at intra*utcriae oneaiaga, 65 

Tumors. Mixed, of uce. 3; Localiation of OHibclir. 
cranial nerves. 5; Brain. 6; Epiduial ialna|dBal, 01 
two years' duimtion, 42; Inve sqgatioatji he wtftaiy 
transmission of differences in susoealibBty toBOwta 
of transplanted, in various strains of mice. 51 ; lKagno> 
sb and surgical treatment of malignant, of kidney. 70: 
of uvnia ooasidering theff fre(|nency« malignancy, and 
recuriaaoe, 84? PMaaaaatad« of aver, iss! Opetaova 
treatment of nbwywnatoas u leri i ie , 169^ of bladder, 
190; Treatment of bladder, 191; of iaterpedaacalw 
region. 195; of carotid body, >So; Leaioas of tisaaaa 
as (acton in development of experimental. 278; 
Marsopialixatian aa method of treatment of some cy»> 
tic. 296; of third and fourth veotridcs, 356; Lumbar 
puncture in brain, 356; of inter- or retrocarotid cor- 
pusde. 357; (iiant-cdl, of os calcts, 373: Spinal-cord, 
185; Concurring, in women, 410: Treatment of. of 
bladder. 427; Diagnoaisof malignant li\'cr, 498; Two 
cases of vedcal. extirpated by bypagMtric route, 338; 
of spinal cord; report of figbfifirB caaea, S9S; Sponta- 
neous, of rat, 5Qo: Primary, of apoaewoaea, $99; 
Study of some diagnostic reactiooa far 
«99; Roentgenological treatment of 530 caam of 
IgMntand other, of (ace. 615; loaportanoe of 
syflsptOBis in early diagnoab of, of oefcbcHi 
ande,640 

Typhoid, Perforatioa, ia lever; caam amodated with 

typhoid appendidtia la cUd aged seven. 1 19; Path^ 
genesis of gaO-faladder iafectioaa ia, (Solera, aad dyaea* 
tcry, 370; Contribution to surgical complirati ons of 
nature o(. (ever, $8$ 



ULCER, Gastric pain in chronic, so; Gastric and duod- 
enal, in newborn, 21; Decapitatioa of dii od rau m by, 
s treataMBt of multiple calona,of 



*>4* 



23; O pera ti ve! 
ii3j|j«J«»* 

•Mocfetad with piaariiriiig' simple, 116; Gastric. 
ioloedag admaaledoanr. 139: Massive 
fraai stoamch withook dkimu iM l is l ib. 237; 
of chioaic of itemach. 238; Gaatwcalic f 
duoaic gastric, spoa t a ne oos can, S38: 



duoai c pstnc, s po 
witb acbloibQrdria, s; 
MHiof iMtricaadi 




rii operatioaa fa 

hi poalpylaric, 377 



TVTKRNATIONAL AMIKACT OP 8UR0BRY 




ilknMl, IMmImI Ol tPMlMB «f 

«f. 6«»; ActiM «f ««M 
li, mtimAin 6<6 

tie Wbiw y —i. #0(1 

UMriat. iUdlMi twil— M of. cmmmi, 6*; pamM dM 

_ of, 10 ■bprtJMi.Ai; |i«towHw4 pwiwiliiiii «lu I«m oI 

404 iMilp hSta S AbSaMi CMltr. 61; Hjrpw. 

■lal. ovMtito«Ciaf«llMpMrfl«(.B9«M,6f; 

ol. caatrf. i(^). OpoMiva liwlaMl 01 1 

•fkMMTMd. low. ittOKKv 169; ChMdi of dac la. 



OIW. IttfctBW oi.7j; T wB— rtc i^ Mwy* fc ti*iV i^l toa^ uuaan^ i 6»; Cy a d i l i of rfac l a. hmmmmm 

43(MiAMlaaMtMtal4wlMlnol.si7 tiMi. 171: f<MnMltvfatioo. 17*; Adda* la aaroMl, 

OMMi, Um of «vaqot. caifcolv •» bcaln aWhi la pcogaaacy. ito; Valot of vagiaal lq«l«aclaaQr la 

wrthaaf t lilBi j M i l a u la. i9>:iilal» lM l uo lB il ifco f. imtaHot of . caacar. •«: Bclapic pngaaaey oomIA- 

Ml anlw ttaoiviMMid htfo Uadiv. «ii; Q i o U fta lag wMk. pragaaacr. 199: EaUap. p H i ll aa, ago; Kay 

Itaoio Mody of vaktt of. calhtlMialioo, 4m ttoo t a w a t of. caacor, ow; Cl M WBlln a la cw of. anra- 




I of . caaow. 4m; GMliatloa la ( . , 

404; Op«aiioaa lor. ibnidi. S'l; SoiptlK of 
.^.ofaiofy I iinnap aad dhgaoM of. caaew. s»; 
Stadjr of aaaioaqr. patfcolapr, aad u mfrnmi of. 
pttilapar. rvctooMO. aad Cfttttotttt 4'5i lalHpMvIc 
caoMo ai« BMootiaaBit oit)! ^Monoaa of« dBMia la 
caiw of waloo wijaltii analiiai. 6t5 
Uwda. *^nMn of. oooHdMiaK thfit ffH|veory, bhm^ 
aaacy« and ioconoa60i S4 



of. npaiaiaty poatar ol fladdw. 191: WACCIKE, Btkbiy of. tnatamt <« pnintw um. 115; 

Sal yaao^MMan. »»^ odnaaMi * tiMnpy to poMbSwi aad lahalMo. jet 
Vacdaadoa, Provocatha aad p i ap l u f i a ak , la vafiatak of 



of. Uadte. lot; Vfbntk of Uaddw iafaala, m8 

, na^aHCjr. jaj. noMpaa oi. dhoov. vagna, 1 aiuMmoB oi BHi«Biy>paMOiHH or obh 

410. Paili of lavolvaaHal la a«Hdlag Wictiaa of, from. 174; Optiariom oo otarai aad, witlHMl 



oact. M3. WAlina of ckioaic iafactlaaa of gMllo-. ilMtk. 5*8 

uact to i*mmn tatmrni dhaatea. 6jt; Aaribaidli Vagiaal. Method for doiiag laigt lacto-. 

■■if III ilaliBi toiiiiiiaaiii. iihIiMj li Vahw of . hjftawctoaiy ia tiaaiaMat of aloriao o 



,^f^ 191; bwala aad to iiaatawBi, stj; 



^_ lavoKod la coaipafi- iacu>>, MpCaa^ 5*4: Racial va., oaariaatiaa la la- 

naof DlHaaa4Ll«li»t79 .bar, 619 



a laDHDBHB; npan oi can. ag» ww^kkMi iiwutanva aas pnpayMCQC vaooaaon ai. 01 

vw ai ikanaiB la. aad tontoaHHB^. mo lalMli. 9^* EpidMMC. la caldna. 6t4« QaMHoa of 

1. lanMBlaan of laami Aaaoto of, dlrtaib- alMiao dbMM la caMO of trahro-. iafaataai. 6x5 



ad Ja H— '^ lyfc; '*''^g«,*7j Valgai < 



ladacaca of at oJcb oa 

__, of.jSj 

caanarfMi wkk akmtimUkotmkAaUm aaliial aa Valae, C o a U gw U lea to. of ofrtaal catbolarimka. t^A 

ao ladtaMv of oMMllvoiliikr^ft VvcMar. I lialaii lor iajartot is6; aiiaaili of owviSi 
nplMrfii; to ilpSaiHa aad dMKtlea, 71 aad cw faih dal ii|^eai ,^7o 

VMooMMar. Maaoaaan wIlB lalMMea loto(dirtaitoani» 
400: IWued jMiaaia aad paphlc, rtianori la pa> 
■ rala la aala. tS; iWwy doriag altor. 47J 

ri»>M»iii» I I ^ I ai. ««. nv" Mat vona* low Vaalai latmoa, ArtkraaM of, aaadr. t^ 

tool la OaalaMai of caaev of. 6>. Patlwtodc. at Vaiaa, Saaiaia aad rfidnaimw Hgatuic of corooary 
aoHpaan.i7t;SypMbof bodyof. i7<;Cni«id.d»- ait«MaaBd.of hHrt. ts 

da[i.i7tiPii|BaalallMBiaWomBlaUnnricii.i%i; Vtonal, Foalapantiva, toraia; ftady of ' 
nrfMBHM aad tadattotosa •!« aaa; Uptlig UM jaolaapialQato, iia:Glaac.lnnia, 

iBMHlMaciaBdftacarcaalvyMiiBiiMlilitiaai- VaauidOhnaMl balM Ina tm\dL trii 
■Mas n caraaiOM o^ 191 : upaMMi nr miv^ aaa loaHn oi laan aaa nam» ^fa 

dawBoaal dhplnaMi* of. a9«« Actiaa af to^atod VaaHaaipaailoa. PiUoch daa la, of alwaa. joa 

Inili MBMaa oa aadaod. of nla« ok. aof ; Dya* VonaHona, Cyatfe dlatatloa of . appadh, 497 

daa la vaataaaaaMarioa of. j»«; Boapto laalia Vartabm. Pndaaai of liaaaiiro paooaaaa of. a6g: 
•ana villi bdbadb, lat; RaMto obiaiaad by ^*\'r\^ \ ^ of ata^aal bdbl iimtl i l la aatam* 

lavoM laliaMi iMa of iMid laBtor. aAS; 

of. la lanofifllihi^bir.|l« 

. ..— ^. Aaaloaiy Vaana, Appaadk^, Mttla. joys calndai la 

^ aaKMaicai prf^ ^vto* 4jA* taoion aaa ipa lad by 

of. 4«i; O p a f i Wa aa jj^^ ^ ^ ^^ 

of. 69a: S4I 




INDEX OF SUBJECT MATTER 



sad 



\mxad IcakMM, IU|kt 
bulki. kpwotaagr; 
UpwtiaktiMi.<8« 
iiilHiiiliiiMtWSi 



of «• 



by 




J* 



pmlyds aad ooatnctotc, 58$ 
\ omiti^i. Prophylaiia utd trmtoMBt o( pott-«nnUwtic, 

of. 



Vdvm, 
V 



^ ^iteuy 



of. 174 

of uterine fiiw>r in 



6»$ 



WAR, OrtiMpodicMmacy ia.tia«,t47; Aneurams of, 
15s, Rente of o^piMMi li. ndtakcy. 161; flbroiy- 
Bin in aoigHX of , aad te dMifan; ibranrsin mna^yiAz- 
i*. 165; Priaauy cstiactioB of, pfojcctflci t6<; Extiac- 
tioD it, prejccqte, »8t; Svifery of, agi; Mechanical 
tmUaeat of (ractana MMkr, conditfaiia. 175; Opera- 
ChrtttwtaeDtofaanniHMiB,30<;Stotiaacaof 1,000, 
opwatioBa. 400; IiOvric* of tpaal cotd in, 504; 
0|Mnthf« tmtaMBt o f. ant uriimi, <io; Cancer prob- 
Mand wocld. 597! Ehctiwayet inmi|enrof, 618; 
MBkri taipveMawgaiMd in Piaaoe, 618: Moat pno- 
tfcaMa plaa far o n an li a tiw i, tminiM and otfliMrt oB 
of Medial Oficen of Che llediolRcaerve Coqia of 
the Unted Stataa Anaijr and Narv and the Medkal 
Oftoen' ReMTve Corpa of United Sutea Arm^, in 
paaoe and, 619; Partial nep hr ectomy (or kidiiey 
wonsd dse to. pcolectile. 634 
War II iiidi, Shril ^Joika fai. 163; Tmtment of, 386, 401 
War wooBda, Hypennyotoaic c o n atr i ctk a of jaw* in, 3; 
limt acnrca in, 14S; Opaa twatmrnt of, 164: Value 
of hnnbar puncture in cranial, 248; Treatment of, 
aa^Miaiaaniieryatfroot. aSi; Gaaeoua cowplica tioBa 
of. a8j; Trcntaent of, 285; Bacteriologic control as 
indicafion of suture of. 385 ; PriaMiy tenaifiate suture 
of, x86; Treatment of. by Catrd HKlhod. 387; Im- 

in, j9s: nmamBmtt p w>w lyri a in. 400; Treatment 
of, 400; PlampahwMMiy. gravity of 
wounds of chaH, 484; TnataMnt of, with' 

fhtftTldf »fK l 

s«9: 

617 . . 

Warfare, Injuries to periplMral ncrvca pradnoed by m od ern 

148; Injuries to ^jiaal cord p tDd a ced by ■wdcm, 38s 
Waacrannn reactioo ia gyaaoMoiy. i7s; Albumin and 

gf*»—'*» coamt of lanHa Mood lerum in health, 

MphBhk nanaaHaiat aad certain other 

wftbMteof fbbalaoa, 371 
IVMl— ■ ii|iiiiBlTiw. nalinplan ij in iiifsiilBi 

S9> 
^Hms' method. Pcnoaal laodilicatina of, (or pyloric cs- 

chaioa, 158 
Wire extaaaioa. 37 
Workmen's coa^Mantioa km, sac 



ide and s spn a dai y aatare, 519; treated b^ soap. 
Malignant infactfaaa of, by anaerobic microbes. 



Woaadi, Aa^aia or 
poalarior aaO of 



paiticaluly of 
haadafMr. 




of 
16; of 
aad Mp. 34 
. of oppar limb, 33; 
of haaft; prolaetilc hi 
no; TMitv-two CMaa of 
ij6; of HaH> nenrca by wa 
taaa operated caaca with end-'reaate. 148; Kidacy, 188; 
Etiofaiy of octtfatf, hi war, 193; S ya ip t oaw aad phy- 
rical dgaa resulthig iwaa. of chiaL ssj; Tataaai ktam- 

pw t Mfj riii hi war, ^; Lau resulto of fanihiH. of 
hand, 474; 11 ai a i n |w ila n aa i y wa r.484; FtftylapaioC- 
oauca pcrfomad wr gaaihot, of abdomen, 48s! 
Axticalar, soo: GaaAot, of blood- veaads, 511; Tiaaas 
fracmeats aad. iaiectioos. 514; Vascular, of ctrvical 
and cervicofacial regioos, 570; Abdominal gwnahot, at 
froat, 583; Effects upon heart 
of blood-vcaseb, 603; Clinical study of 



of. 



infectioa; gaa ganpene, 617 

nt of, 383, 385, M»; Specific serun^ 44: 
Salt poch treatacat of iafected guaAot, 59; Reaievai 



Wounds. Treatmeat 



OC MIDCVlOSCCAl DOBS OBBHOHtB iB DiOHBRT tVBOCIfelBKOl 

•r^er^, 14a; D oae s utur e hi gramdating, 143; 
Open, m war, 164; I>r>-, 34$; Value of lumbar punc- 
ture in cranial war, 348; Treatment of. of heart. 3^: 
Primar>' immediate suture of war, 386; TraatsMat of 
war by Carrel method. 387, 471; Rose irrigator for 
supplying a therapeutic 8aid ooatiauoualy and at a 
temperature to whole aarfaoi of, 351; Immediate 
spontaneous oblitesatioa of larjie fimb arteries in war, 
395; CkatriflUfaa of. 398, 399: llavine and briUaat 
greea in treatawat of Infected. 473; Immediate treat- 
ment of thoracic. 480; Eztrapentooeal. of asoeadhig 
coloe, 497; War. treated by soap. 519; Ticataseat of 
war, with mnaMiiaB chloride and secoadaiy satave. 
519; Peoetra^g, of ocufatf globe, their treatawat hi 
army. 544; Treafeat of aaaiaL gbg 
Wounded. RAle of orthap«iic sa^nyla twataieat of. 183 
V-RAY, Eventration aad hara ia dk^n^mAM utm 
'^ roeatge nn log ica l vievpoiat oblahHd fnai CMas 
diagnosed with, 33: SMa caaoer aB<odW.4s; Ortonr 
of aqnnsarooma ticatad by, 43. Coafental aaomafies 
and variatiooa of boay shcleloa aa revealed by, 58; 
Comparison of. picture. 60: Postopeiativc, treatascaC 
i0 malignant gwmths. 160; Skin cancer cured by, 171; 
;c«lb.s79;ti 



andlivngce 

trrsfawaf ofgaaltil caidaoaa, 409; Wor th of aa 
early, er andaa tln a ia gastric caaccr. 490; Dalactiaa 
of fw hi tlMoaa by. 517; Scope aad teehaiqpi of, 
thmpy.jir; Myonaa aad, UetfaMat, sta; Slady oC. 
of caaca of (lacUin of loag boaea, S9^i appcaiaaoea la 

614; d hposi s of pa ia tiwMa. 614; 

■d ticatacat of thyioU 

ovarian inacHnliQa ajr, oso 



INDEX OF BIBUOORAPHY 



' c«A.*AA ~ ' . ». •!. •««. J«7. ♦«. 

AMilkMfAMlHplk tavinr. as. aoi. ji 7. 4JI. S4t, 



tftktBmimiirmk 



*«T. 



"^ISi?S%b,2:':SLSs 



o< »wr 



jfeadk UwdM Mid 
TkyvoM 




•JI^«J^4M. iifr ^ 



PlMfyU Md ff l l ll lt i f , tf. Mi. JI9. 4J«. $51 



•7. »o«. J«9 43*. 




Gwim-lalaMiMl TiRKt. fi. ao4. 119. 4j6.SSi.«47. 
8lapick ipd pyknic O«odmm. fail ■»• 




89, MS. JW. 4J7. SSJ. 
•». M*. l«l. 4ji. SSS. «49 



ofBaMi.lalMi.MMdM. 

MOMMly FoMdtetka 
«^ M6. If I. 4fl, SSI. 649 



9^ m6. jfi. 4jl. SS4. 

Smwmy ol Um Bomi. JolMi, ale.. 01. mt. |t«. 4J9. 

SS4.AS0 
Ortkopodla la frMiBl. 91, M7. JM. 4f9. SS4. *St 



^UmSHmd Ctimm mi Cm4 

•ad Doiar Mid M af Ika Spiaa. 9a. m7. jtj. 



Gai4 

tf Ikt Ntnmu Sftltm 

KorvoM Sfmm, 9*. nt. jtj. 4«». 1%%. 6st 
laiuMMaoat, taMMM, Mffvy 



kil BaliliM — ' T^UMM. C 
OS. m8. jaj. 440, scsTosa 
TttOMn. Ukan. Ukai 



SoM, Voodaat, aad F( 

«S* 

SaraM. Voodao. P< 
Aa^hgrlKrii. 



mem, 

ShodL IV 

flS. Mt. SM. 400. SJft. 



BM.«StMl,sa4,44i.Sj6.6|« 

Blood ptft w t la MaoiaL BaMonaMk Obi 
latloa. T hro adbook. BMboB— . TiaMfMba 



Blood aad Lyaipb VoMb. 9s. M9, JM. 44i. Sj6. 6<< 
AacanMM. VomcI ntuio aad Bfoika. Lym^ 



DIagiMli. Patbolou. aad 

Mtfal SaifHy aad Saqpeu AaaloMv. 01. 
M9. S>5. 44'. SS7. 6sj 
BadUoiy. 94. <i<k J»S. ♦»». 557. *54 

JUay. Bbctricd tiMloMat. naMbmaf^. 
hanr Sipptjr. 94. »o. jis. 44<. 55*. ^ 



ttTjW. 445. 55*. 655 



OKMBOOMMIT 



9S. » lilt7, 441* SS».H 



lonaaiioat. 
aad 



SUi?'!^ 



Mai- 
fft, til, j»7. 



96, tit, itT. 44««9to. •SS 



INDEX OF BIBUOGRAPHY 



oBsnniCi 
PragMacy ud lu CoMfrikatioM, 97. ait, js8. 444. 

rma «*^^ Aboraoa. CMBpttcatkMM 
Labor ud lu CompHcalioas, 97. aij. 3*^ 445. Ste, 

Coamdid prfw. AbaofaMi picMatatioot. 
Djfflloda. BMaocraaflB. au n i c al ticatnMst 
Pw p tritt m aad Its Cwiplkmoat, 97i *i3.J*9.446> 
S*«.6S7 

I coowion to InfoctkHM. H ammih af 1 
97. >ij.3>9. 445. 561.657 



BUdikr. 
TiaaaM. 



orriiMv, taaMCSa uiABaiHaliiDaa. w 



S6a.6st 



Gcaiul OfBUH. 9B. >i4. JJCk 447, s6a. 65S 

Tdtidc. EpkUdymb. Spanaatk cord. Pratlalt 
9*. >i4. Ije, 447. S6a. 650 



SUKGEBY or THE EYK AND CAI 

Eye. 90. Its. iio. 447. 56*. 6j9 

Glaucoma. Tracbooa. Gataiact. I 

Ear. 00. J15. 331. 44i). 563. 6S9 

Outer ear. Middk car. lataraal aar. 
toids. Brain abtccM of odtfc ocigia, etc. 



GCNITO-C7KINASY SUtCERY 

Adicoal. Kidney, aad Ureler, 9S, 213,329. 440. 501. 

Adiaadglaad. Kidney s Uwtaw 

hMaDCfhifB, taoMin, inflaauaatioaa, miiery. 
htnctioaal tests o( 



SUKGEKY or THE NOSE, TBBOAT. AND MOtnV 

Now. Throat, and Mouth (oral sorsery) 99. si6. jjs, 
44«. 563. 660 
N'oce: external, iatcnial 
Throat: toatfi, sdMioidi, lagrt. pbMyi 
Mouth: palate, deft palate, teeth. 
General conditions 



INDEX OF AUTHORS 



AHMk A. tlf 



. J.W,4IT 

Mara. E-, i7» 
AidMBibMU l», jM 
H. M^ I7« 

. I. r^ jM 



A«liB.j.lL.ii9 









Bmt. L.. joo 
BMk^.ll.SM 



r.'c. a, ij» 
Lj.r,4j« 

BMMnr. tt 
Bwr, B. Ai^4Q0 
B»K.I..%..fO( 
Bannt. I^fry 
B«nw. I* . jfi 
r.CS.. 




rf.J..4i7 



■3;^"** 



, E. G^ t to 

v.tC*. 




P..60 
J.N..404 

iaTaTL. i«7 

C . I'lo. SJ4 



Mmh« W. W.« jn 
Bhek. tt, s«7 
BIm1.A.. Ill 

E.SL,ij8 
l W., J7 






A. 1^174 
. S. H.. M 

. F. *ao 

I.J..IS6.SJ* 
>. E. A.. iSj 



B«g». E. A.. 10 

O0MI« < 



H. Jm6i, 171 
" C.. IS4.509 



419 






C.J7 

•^ 7*. ««7 



.O 

Jn,«»7 

J;. »44 

;L-.4a« 

CCafo 



9 ^** • *v 



S».4<S 



*i!a 



Brack. G.wTi« 



Bnlw,Ct74 B«wii, 



,JA..s«g 
Bfowa, J. Y.. j6 
BmwaoL C H^ 47* 
Bnmrf. H. F^ si» 

Brymal. W. S.. Ij 
Bwum. C. B.. 406 
Bwlov<H4aMO, vos, 40 
B — if i r . L.. 190 
Bogbn. II. G.. 180 
Bh, p., I $ 

P. D.. sqS 
C-.409 

. G. E.. J95. SM 
J. E . i6j 



Bvnws, M. T., 60Q 
Byfofd. H. T.. hs 

Cobot, Hnio6. 310 

GMft«fyrwrw..46 

Code, A., tt 

CdkKC^4<4 

1.A.M..J79 
I. D. M.. 196 
' W. C, M, S90 



CuapbdLfr P.. i>s 
GUMMMI. W. 



r. B.. 479 

Conwdjr. i^* eT. ^4 
ConaHo. E. A., J14 
Cwfal. A.. J98 
Correva*. B.. 429 
Carter, R. M., jos 
Cary.W. H^t78 



"•. B^ 114 
Cattanaok, G. H., SM 



A^«7 

. V...U 
CkoHlea. P. R.. 176 



Oottatooi. C C 14s 
r, D^ 141 
jr. A. M^ t6e 
S. B., j6, i6t 
"■I.A.. 17 

OuM- G.. 4J. 40« 

SoSTp. B., 141 
Codinr. C G^ ji« 

Coe».A.P..S99 
Coka.A.,146 
Colo, H. P^ loj 
Colo. L. G^ S77 
Colt. P. P^ $ii 
Calor. P.^i7i 

ColiiL&,s64 

*7^ 



J. A. C tyj 



Ooibttt,J. P^jo6 
CoitMlw. R. D^ 066 
ConN«B. L. If.. 6a 
Cofpoo. /. N . is6 
Con. R. 61B 
CoiU. R.. iS> 
CotU,T.. 14 
CoCIo, G., 60J 
Colloa, P. J^ j6. sAa, «6I 

CoMViWf t A>« fon 
Cimbcioe. E. C. jo6. 310 
Craig. C. B.. 14S. m 
CmM. C. C. J15 
Crik. G. W.. »» 
CiMn. E. L.. as9 
CtoiiM. H. S.. 179 
Crow*. S. J.. 641 
Craet. P.. soi 
Colbcrtaoo. C. 409 
CmmiMhoM. J. B.. Jr.. 

Caitb,A.H..sjt 



Daboiy.V..8i 
Dwklfar.H.W..6is 
OMMljr. W. B-^. ISS 

Mr. w. 1 .. 



S«7 



Dovia, B. B.. Ill 
Dovii, C. H., t96, 4«a 
Dovia. D. I.. seS 
DovKD.M..(i 
Dovia. B. P.. 67. 180, 184. 



IVAiqr, C. joa 
Damck W., 141 
DavUTv. C. as3 

i.A.J..$87 



laAi, 



G.G.,jio 



Davia, L.. 10 
Davb.M. M.Jr..6|a 

Daaa, R. R.. 601 
Daarbom. G. V.. 46 
DoBvor, J. B.. 169 
IMM)n«.>49 
OoCmIio, A.. ISJ 
DtktMf, G.. 147 
P., toa 



DoUt,!. B. i8s.4i$.^ 
F. A.. 



MmB, W. IL, •9S. S>4 

A^ av5* 4*^ J"^ 



9>?( 



14 
B.. 110. s8* 



INDEX OF AUTHORS 



ncxv 



DickiBMo. R. L.. 65 
DkflcakMch. W. H.. i6j 
DofafowoliUK N- A.^ 59s 
DodMo.G. E.. 511 
DolMa. C. 67 
DoMMiiri. L.. IS 
Doflaod. W. A. N.. 193 
Dowdeo. C. W.. j6i 
Dnpar. J. W.. 1 18, 494 
Dnyti, L, A95 
Dnicck. C. J.. 368 

•d.H..S78 

If... 



IMbwdJ 



DabiB. H.. im 
DmBom. F. G.. 407 
DveoMdd, v., 397 



J.*67 
DUBOU. C H.. 534 
D« Nouy. P. L., 399 
DopCrtt. R.. >69 
DapoBt.497 
Dmnte, F.. 144 
Doiaatc, L., 9 
Dwham, H. A., 505 
Dwkcc, J. W.. 314 
Dwovx, E.. S06 

Dyat, F. G.. 141 

Eacletoo. W. P.. 640 
Eastman, I. R., >s 
Ed4T.I.H.. 119 
Eikw. J. C. 68 
Edbgtoo. G. H.. 13S 
EdnMXid. W.. 586 
Ehmfried, A., taa 
Dwii, P.. 57a 
Eiwiidrilh. D. N.. ?«. S4i 
Elliott. T. R.. 383 
Ely, L. W.. 50s 
Eofs. L. A., 180 
E|i^cia,S.. 366 
Ercke*. F.. 493 
EidnMUU, J. t., 39 
Ewh, P., 414 
Eacndero. P., at 
EaKS-Modkr, E.. 181 
Estcs, W. L.. sao 
Ettor.E..494 
EaitcnBaa, G. B., 574. 608 
EVMM, F. A-, 499 

Furchikl. W. J.. 533 
Falk. K. G.. 608 
Falkenbcn, las 
Fan*, F. H.. 104 
Fadaai. G. M.. 104 

V^bki^ eL ' a86 
Fcaacr, E. D.. 367 
Fcniuk-Widal, 166 
FcnBHUBi, A., 498 
Fettamlf , G.. 483 
FtadM,D.,4a4 
nBlMlMaia,B.. a64 
FlKher. H.. 396 
Fitcfaar. L., 363. 591 
Flacter, L. C. 358 
Filter. R. F., I M 
Fbkc. E. W.. 3^ 



I, P. J., tea 
,-Jbar. R. S., SI 

Fobaa./.H..3Si 
Fofbca. H. II.. 546 
Foraaaa. J.. 1 10 
Fonaatcr. C. R. G.. sot 
FocMDer. H., 173 
Fortuaet. D. de, ai 
Foater. C. S.. 378 
Fowler, R. S., J7t37i 
Fowler. W. F.. 580 
Fralkh. W. G., 4S 
Fraochini. A., 13s 
Frank. L., 49a, 635 
Frank. R. T.. 6aa. 633.635. 

«S5 

Ftaaer. J.. 59 
Fkaaer. I. R., 407 
Fraucnthal. H. W.. 381 
Fredette. J. W.. 513 
Frdbeff, A. H., 33 
Frcach. T. R., 83 
Freund. H. A.. 394 
Friedenwald. J., at. 115 
Friedman. G. A.. 134 
Friiiac. G.. 40 
Ftamacet, H.. 439 
FuWj. E.. 379 
FuUertoo, A.. 190 
Furaim, H. D.. 67. 306 

Gaarenstroom, G. F.. 518 
Gaoulea. F. J.. 146 
GaUxaitk. W. W.. 586 
GaDego, A.. 105 
Gallie. W. E.. 34 
Gant, S. G.. 497 
Garber.J. R.. 186 
Garda. F.. 56 
Garrakan. I. P., 14 
Gatdtkr. J.. 570 
Gate«ood.48i 
Gaudier. H.. 386 
Gaylord. H. R.. 598 
GeWe,47 
Gate. S. H.. 40s 
GcOkorn. G.. 537 
George. H. T., 357 
Gcragkty. I. T.. 191 
Gerlach. W.. 493 
Gcfstenbcrg. E.. 403 

Gcrstcr, I. C. A.. 144 
Gcwia. W. C. 358 
Gibaoo. C. L.. 513 
GOfl. G.. 139 
GIbert. O. O., 607 
Gflbartl,PM48i 
Giaabaii. H., ao 
Q0vaaM.O.. 116. 363 
GiRms.L., 13 
Giiwn, R., 166 
GittiMi.J.C..483 
Cu ebl ik|«r . 300 
Goets. P.. 533 
GoodoMB. C. 5> 
Ceya— , I.. 33 
Giadealio. 196 
Gfadaain. G.. 196 
GndwoH. R. B. If.. 637 
GrahB■^ A.. 375 



E. E., 101 
Graowa, K., ti6 
Grant. H. H.. 140 
Grant. W.W., 137 
Gravca. S., A97 
GfMa.G. W., 41a 

Gicy. E.G.. c 
Greene, O.. 185 
Groa, H., 439 
GroM. G.. 616 
Groiamaa. J., 530 
Ground. W. E., 347 
Grubbe. E. H.. 43. '71 
Gniner. O. C, 579 
(milbaud, G., 368 
Guildal, P., 618 
Guillain. G. 504 
GuOleminot. H.. 161 
Guillot. M.. 147 
Guiaez. 103 
('•ulbransen, R.. 473 
Ctunnar, M., 570 
Gutkrie. D., 36. 30 
Gwatkmey, J. T.. 346 

Haas. S. L.. t8 
Haberer, H. Von, 155 
Hackenbruck, 379 
Hsdley, .M. N., 516 
Haines, W. D.. 138 
IlaU.A. J.. Ill 
HaU, J. N.. 408 
Halliburton, W. D., 505 
Halsted, F. S.. 437 
Habted, W. S.. 40 
Hamburger. W. W., ao 
Hamilton. H. C. 396 
Hamm, A., a 
Hammond, R.. 58. 518 
HaBea,F. M., 476 
H*rdoy. P. J., 355 
Harris. S. H.. 418 
Harris, T. J.. S4S 
Hart, D. B., 187. 533 
Hartert, W., 357 
Hartmaaa. A., 398 
Hartmaaa, H.. 533 
Hartmann. S. P.. 177 
HartunK. A., 58 
Haru, H. J.. 406 
Harvey. S. C, 49( 
Hatcker, R. A.,6ta 
Haultain. F. W. N^ 183 
Haynca. I.. 488 
Haytkorn. S. R.. 60a 
Bcani. A. G.. 183 

I, M. L.. S06 

W.J..43 
A., 190 
1.O..386 
P^ li- B ay ar . m 

, A. M., joi,4ai 

-"?.;?„ 

I. M. S.. 38 
I. G. A.. 137 
Bcwy. H.. 383 

K.. to6. 393 



HMtmar. A« E*. la. jo8 
A.. 390 
A. F.. 398. S07. 5»J 

1.W..165 
Heoar. G. I.. 6. 355 
Heyd. C. C.. 39 

CA..609 

R. i«i 

L, J., 135 
Hfait.J.C.,4iS 
BoH^ 1^.4^3 
noimaicr, 519 
Hofmeirtrr. II.. SSS 
Hofaa, E. P.. 393 
Hobea. F. C. iM 
Holdea, W. B.. 363 
HoOaader. A. R.. 565 
Holm. P. F.. COS 
Holman. W. L, 53 
Holmes. G., 474 
HobBca. H. F.. 600 
Holmfica, G., 484 
Homans, I.. 363 
Hoover, C. F.. lao 
Honms. G., 387 
Hocriey. J. S., 37, 108. 156 
HortokMBcy, 358 
Hosmer. A. J., 368 
Houasav, B. A„ 53 
Howard. C. P.. 353 
Howard. H. W.. 307 
HufuMcel. K. F. V. Jr.. 518 
Huj{h, W. K.. 399 
HuU, A. J.. 606 
Humpkries, R. E., 505 
Hunner, G. L.. 93 
Hurd. L. M.. 43> 
Hurwiu. S. H.. 389 
Hutckins. H. T.. 64 
Hyndman. C. E.. 501 

Iglaiaer. S..81.198.431 
Imbert, L.. 3. 38 
loapcratori, C. J.. 316 
laffebrktaaa. R., 4>. M* 
Iroas,E. £^84 
lveas.lf.H.F..6t7 

ack. W. R.. 394 
D. Er$7 



H..t83 
W. R.. 17a 
, A. C s^s 
\ H.. 169 
.480 
aidiae. R.. 66 
(aageaa,6i6 
[•dBcka.J..566 

98, G.. It6 

^iatags.y.E!.a6s.49S 



U:'" 



__ «5$ 

[oarirtL^s85 
[okaOi.W^t6e 
okana, F. >!.. SJ& 
W. M.. to3 
W. H., 80 
L..t89 



BDnH 



DfTBRNATlONAL ABSTtACT OF SOlOnV 



B.C.4lf 
k)r,B.Ll.4rt 

r. D,4n 



■l Jn ■■• 



SSJ^lTcjic 




Uitdi*. II . 14*. •«« 
L«it«fc. M.io« 
U«lm 1^ JIT 

LMb. n. S.. 7». 606 
Uvi it6 

La*** 4ia 

LVnPBML jB 

F^tff 

Loekiroad. cTo^ 134 
^••■w/f^tTj 

W..44I 

I^OtM, n^iH 
Lawt. J. iL, s*0 






LoMr.W.l,Mft 
Uwi,f.¥..j74 



M>.J^«4 



Lack. II L.a* 

UPMn.L 1:'. ui 
UlMqr. r. U., sn 
LuBMft. F. K.jst 

I. R. A^ tTfk PI 

. r^ij 

LaMfM.N\ aAff 
" Mai^G 't' 

r.cj.t 
^c. r.4i9 

M.C.SS4 

AW,i*.,» 

La Twia. F^ 174 
l iiiii H .T ^t94 

Lmv.A. A^MO 
Uv. f. M. jtt 

li imi.W.s^jTi 
Lawln, F. 1^ sja> ^ 



UqrMar. ijT 
LyMk. 11. L. 197 
Ljradi. J. M.. 1*1. 40« 
LtkIi. IL C. 8a 



LjTMi. F. S^ lie 
I41—, C ~ 
LFtft.C 



^i:« 




ucvr n to* 



R-JOa 
W.M...J 

, »77. 4*4 

, IL, tfi 

Mackf.O. R^41* 
" ■ lKj.ii6 

II.V^47i 
A.T^a4$.»4 

•n4n 

JS7 

9 It. CIO 




ltoi*«a,J.W^ f04. If*. 

Manlnl, I. K^ Jr^ f • 

MaiilMl,W^4|t 
ManllSo, G^ a^i 

Maitii^^iM 
M«fftlMi,Ka|i 
llartiyw, P.. J 
llMiil,LC..4ai 
Mtthmr A.fc.40l 
K. C. js* 



A.T..af7 



MayaUH.. 591 
llaf».CII. i6t 

Sc)SilMBr.Llli!408 
licClw«,aLD., 13a 
IfcPlulaad. W.L. laj 






McKcaaa. C. M.. 417 
McKauk. R. T.. soj 
McLma. ). H.. 416 
McNaaaia. S. j.. 631 
McPlMtaoai, R., 181, 6a7 



mUiMtttty. A., I 

llcRaa.F.W 



*Si3 



McWilaiM. C A.. 
laa».J.H:.399 



<4S 



—.•4 

r, M.. 410 
i.L.B..6ii 

Maadaadt Lao^ If . A^ 404 
MavDadi. 8.. a8i 
MartaM.s8| 
Malta, B. O^ 7a 
McTW. K. P.. 389 
Mayar, L., t8a 

Mcvtra.!. L..4n 
Mittar. A. P. W.. a74 
MOkf. I. L.. 130. is8 
Miller. R. H.. 14a 
MOkr. R. T.. 403 
MiU«M. E. T. d, aj6 
M1m«,G. R..ijt,t7i 
Mllckal, A. Grails 
MkcMLV.B^Qi 
llodk.H.B^«ti 
M o cq aot.P.. a6s 
Mafatt.J.j.,S47 
Mnlaii, if8 
iiiilM. L. m 
Maora. G. A.. j6 
Moon, I.. 198 
M«eta,I.J^4ia 

Moaaa, S. G~ 6it 
MoenkaaO. K 8ls 
MaalB, C W^ t7a 
V-I9S 
P^.iff 



MuiiSfifr. 



,G.C|M 



,K^8m 
M«cfca.V.4>s 
M«lar. K.. 149 

>l«.«y N 474 

ilaiol, sai 
Mwmir.G. M^48 

Myan,KlLri4 

Nadhr.W.II..j84 
Nitfa%w.ILC^ 

NanCT'.jai 
Kaoaa. C. P^ 35a 
Navano, I. C, a4 
H aal,F. B^4io 
NatipBMar, P., a6e 
Wiiwla—iia. 848 
Nav,G. B.^418 

«al.W.8^6o4 

I. C. A.. 600 
NklMb. II J.J70 
NBa«.C. M.400 
NI«.J.T.. Jr.. 119, 5*7 
NoMeovft. IS7 
NoUa. C. P.. sa4 

Naciar.T..43 
NopMlfa, A.« 79 
Noma, C C. 17a 
Novak, B..a97 
No»8Jowt»ail.G^ji 



Natt^XJ.lBi 
^T. W., ai 



Niuttm, 



r.A.!.. i.asi.fia 
H.. IJ7 




*"*'\i* 



c.yt.. Kt 

Ovr.D 
Orr.ll •< 
0rth,0.,SO4 

Owaa, W. B., 1 39 

PttiM.C.D3Stl 
F. W^ 3n 



^r^cY"* 



SB^f*& j£ 



39 
A-UMi 

^0^3?S 

.Tm43* 
V^ a3. af8, 331, 






INDEX OF AUTHORS 



uuivfl 



\ 



Paym, R. L.. Jr., 7S 

Pta, D. dt b. 56 

Pnoock, A. H., 75. 418 

Paucc. K. M., 154 

Fnm. H. E.. 1S8 

Fmwo. W., 510 

Pick. C. H.. lis 

PiKk, J. L., 5te 

Hekimai, F. E.. j68. j8i 

NIoCjo 

P. S.. 190 
•.J.D.,11 
r. 0. P.. *87 
1. F^ arS 

Pwcy. J- F., JS4 
Pemn, P., J87 
PctMiOD, R., 6>5 
PBjrre. IS7 
Pfaff.O. G.. 5J9 
Pfahkr. G. E.. 11.354 
PlMtea. G. W.. 301 
PUUf*. W. C. 640 
PhflUp*. W. D.. 64 
Plcoudo, I. J.. s>i 
Pkcmrdo, T., 65 
PIccsido. T. J.. 173 
Ploqaet. 6u 
PinoB, F. E., 7 
Phroe, G. H.. 41 1 
- i,N.IL.54$ 

r.I.D.. 195.514, 6a$ 

r, L. S.. 587 
_ r. P.. 537 
PfaK A- H^ a8i 
Pfroadini. E., 634 
Phra, A.. J69 
Pb». E. D.. 187 
Plua, H. L., igs 
Plommrr, W. A., 35a 
Plttminer, \V. W.. 380. 385 
Poirt, 300 

Polak, J. O.. 18. 301 
Policard, A., 400 
Pool, A.. 430 
Porter. M. F., 357 
Pocteafer. J. E.. 379 
PoUcr, C. 470 
P»«t.34 

PriaroM, A., 154 
Priaee. H. L.. 373 
Priafk. J. H., 135, 145 
Prior. S.. 193 
Privat. J., 3w 
Ptttaaai, F. ).. 315 
Pytwi, F. C. 583 

E.P^ii8 
1,B., lai 
D. W.. a46 
E., a8i.400 
. A. J.. 61 « 
, W. A.. a8o. 615 
D. 7 

RacUord, B. K., 614 
Radio. M. v., sg6 
Rac, J.. a47 
Raiaat. M. F.. 199 
Raatoboff. I.. 6a 

r. J. L., 62 




Ratsraaki, M.. 519 
Raaetti. L., 11 a. 395 
Real, P.. 3 
RlfmiCT, 137 
Rcder, F., 408 
Reed. C. A. L.. ta4 
Repud.C..43 

RciclMl.490 
Rdd. U7k., 49 
RaiMkiM. H.. 140 
RcatOB. J. M.. a75 
Rcplo^. H. B.. 566 
Ravaoida, E.. 177 
Ribaa Ribu. E.. a94 
RIcbaida, W. G.. 490 
Richaidaoo. C. W.. 8a 
R fch a r dwo, D. T., 5u 
RidMidaoo. E. P.. 360 

Ri<floo.J.,4i.3S3 
Riedai, ia8 
Rioaafido,385 
Riacbbiedi. H.. 108 
Rialey. E. H.. 470 
Rivctt. L. C. 36 
Risqua. I. R., a8 
Roberta. J. E. H.. 59 
Roberta. P. W.. 38a 
Robcrtaoo, T. B.. 613 
Robcrtaoo. W. A.. 488 
Robtaa. C. R.. 171. 6a4 
RobiMoa. E. F.. 478 
Roffo, A. H.. 108 
Rofoff. J. M.. 50, sa. a76. 

Rdidcabttrg, G. L., 598 
RoiBaB.D.,370 
Roocy,A.J.,4t3.6a9 
Rooat. F.. 8t 
RoacMoha. M., 6a8 
Roaeathal. 568 
Roaeathal, E.. 491 
RoChfucba, 356 
Rothholz. A. S.. 641 
RoaajP.,608 
Rouancreiz, 38 
Roath, A., 4». 530 
Rowiar, 349 
Rovriaf. T.. 38, 75 
Rowe. A. H.. a7i 
Rove. L. W.. 353, 396 
Rowt, R. G^ 55 
Roy. D., 83 
Roy. M., t 
Royitoa, G. D.. 5a5 
Robia. I. C. 75 
Rota, C^ 41 > 
Ra^J.T.,594 
RoahaMnLS., 303 
Ryaa, A. H.^ 60a 
Ryanoa, E. S.. 154 
Rycnoa, E. W., 37 

Sacha. E.. 410 
SaiBt.300 

SaiDt-Mafftia, E^ 4a 
8HMr, F. D^ 471 

Saraikinti. J. A.. 33 



G.R..364 

, A., 614 
Sajna, R. H., 38a 
Scaadola, C. 348 
gfk a rhaar .A.. ia6 
SoMcfef, P., 409 
Schaefler. J. P.. 569 
Schaldemoae. V., 16. 39 
SdMrck, H. J.. 637 
SeUUiiM. H.. 190 
Mimiwirn . V.. 143 

SHinrffi. H., 4«i 
Srhnritor. A.. 539 
Scholu. O. T.. 543 
Schultxe, 356 
Schwartz, A., 36$ 
SchwmrtJE, O^ 635 
Schwi^er, H.. 395, 510 
Scott, £.. 1 10 

Scott. J. R.. 199 
Scaddar, C. L., 14a, 491 
Sabfleaa, P., 348 
Seefiich, G., 164 
Seaura, G., 17 
Seibert. O. J.. 135 
ScUfochi, S., 571 
Scaoert, L., 144. 165, tSa 
Scrafini, 6a6 
Serafini. G., 586 

Seybold.J.W.,567 
?>hamhau|h. G. E., 546 
Sbarpe. N., 594 
Sbarpe. W.. 3J4 
Sbattock, S. G.. 496 
Shaw. H. A., ate 
Shaw. J. J. M, 485 
Shcehey. J. J., 294 
Shd&dd. H. B.. 257 
Shaldoo. R. F.. 590 
Shanill. I. G.. 122. 152 
Sharwood-Dunn. B., 361 
SUplcy, A. M., 310 
Shohaa.J..57 
8hoftle,AG., 110 
Showalter, A. M.. ia3 
Shrapahire, C. W.. 309 
flh«d. 398. 410. 
" i.M.,48a 

J. P.. 391 
C. A., 107 

r.j..5« 

I. A. O., a 
R. E.. 4>i 
Skflkm. R. H..431 
SUnriM. R. S.. 16 
Skaag, A. L.. 385 
9M0W. J. M.. 531 
flbaa^. G.. 8. 576 
soa, M., 600 
SMith. E. v.. 40a 

flakh, F. w.. 540 

taith.M. I.. 54.8ta 
" \ R . 3*7 
R. M.. 71 
R. R.. 175 
T. S.. 199 




SadtUaa, F.. j6a 
So6a.A.. 194 
Solar, 414 
Sder, C B.. 105 
Bj.66 

SpcaafaL ia8 
Sqoier. /. B.. 76 
Stacy. L. I.. m6 
Staatoa. E. M.. iia 
S t a prim o hr . S. voa, ita, 

S73 
Starr. C L., 118 
Starr. F. N, G., a63 
Sutham. R. S. S.. 59 
Suuff. S.. 605 
Stcbbii«. G. F.. 47 
Stda. A., 174. 184. 5s6 
Steiadlcr, A.. 386 
Stdlwacea, T. C. 311 
StcphaMoa, C. E.. 38a 
Staiaaa, A. R.. 537 
SCevcaa, R. H.. 162 
Staraaaoo. G. H., 485 
Stewart. G. D.. 491 
Stewart. G. N.. 50. 516 
Stewart. W.M.. 517 
Stidl. W. F.. 591 
Stioccr. E., 497 
Stoae, H. B.. 27 
Stooe, W. S., 6a. aro 
Stoat, P. S., 84 
Stroem, S., 31 
Socittra, K., 608 
SmUt, B. H.. 183 
Syma. P., 377, 48a 

Tanbcrs. A.^97 
Tanner, H. H.. 351 
Tantoo, (91 
Tantoo, I., 586 
Tappciacr, F. H. voa, tM 
Tauiaic, F. I.. 64 
Tajdor, A. &, 58$ 
Taylor, H. L.. 39 



Taykir. K.. ju 
.R.T..36 
*. J- H.. 304 

TcOii^. W. H. M^579 



Taylor, 
Teacher. I. H. 3 



T«aMta, 575 
TiMteB. C. F^ 80. 81 

T.T..40O 



ThoaMa, 



W. G., 373 
Tboaaa, H. K., 533 

W. F.. 499 
L. H. D.. 47t 



. W.. S4J 



TItaa. P^ 4«» 
Toaiaiad.W. 
Tncf, S. K.. 170 
Truaiow, W.. 380 
r. T^ 401 

T^iraar, G. G.. tto 

Ullrich. A. J.. 39' 
Uaaaa. R.. 4*7 
t'icatt. 267 



DfTBRNATIONAL ABSTRACT OF SURGERY 
.A,C4 W^Mr.l.lL.|S7 WflsB.a,teo WIm».W.T..«7 



VM^Em^^ INMmilCW^ivI W«ln.T.A^ij« WdlMkCC.^ii 



VMB^t.M^^ INMmilCW^ivI WflMn.T.A^ij« WdlMkCC, 



. Waftflt: J. W. >..!•• WMMa<i, tf» WM^raf . R. W.. 54« 

4* Wdl,dA..4ei WliS5ri.R>.SH Wi^|M,A K . jsi 

VlM,w7Elt9i Wu< P. ft.. SM WUli.F. W. t;s WrMt.O.W.J..sii 



Viiiiiii.a.»U WteMkfn. ^.. 40J WlMw.8..6t Y«MgB««. ><•. J9o 

VImhM, ts m. J9» Wanwr. P., ist.6»» WBatky, A. 0. 114 Yio— 1. F. C. i>o. ms 

VImMI. ■. N^ S*4 Wathn. I, R.. «4i WBm. ST^ Yo«^ llll . 63JI 

VIn^mM S^«iJ!^5:V*•• SS^^'J'^^ YoiiiH.j.t..i47.j»5.Joo 

Vli«6, J^ »»_ WMfciM.T.J^ •!• Wpii^ rf. (;. R.. 300 



L, Jit WatoM-WMhat. F.. to WMum. I T.. 40s. 6aj 

SM W4Lr. K..4^ Wlm.A«l,S7« aoMMni. A., sti 

WS. H \.tit wSiwi.ll.. 617 WlM.irB..9.479 Mkk,J.D..ii 



. W.. 41J 



INTERNATIONAL 
ABSTRACT OF SURGERY 

JANUARY, 1917 



ABSTRACTS OF CURRENT LITERATURE 



GENERAL SURGERY 



SURGICAL TECHNIQUE 



OPERATIVE SURGERY AlTD TECHNIQUE 

McQ u — B >y. A.: Carbohjrdnite Feeding in Sur- 
tkal r«tM Am. J. Smrg., 1016, xxx. J64. 

McQuerney believes that acetone formed as the 
result of the action of ether upon the organism, and 
the by-products of a rich protein diet following 
operation, are responsible for many of the post- 

3>erative discomforts and for faulty wound healing, 
e tried out a ^>edal diet, as follows: Before 
operation meat and eggs were elimiiuted for a 
period of three days; after operation for three days 
a solution of malt sugar or 20 per cent dextromal- 
tose was given, five ounces every four hours if awake. 
A series of 34 test cases (corliotomies) under this 
regimen healed clean, and without any disagreeable 
symptoms, such as ncr>'ous excitability, distention, 
or nausea and vomiting of any considerable degree. 
In 46 control cases of a similar nature 7.5 per cent 
(denn cases) became infected; 75 per cent had con- 
siderable distention; an equal number were anxious 
and exdted; and 85 per cent vomited or were con- 
tideraMy nauseated. .Xtacrr EHKr..vrKiiu>. 

Ochancr, A. J.: The Prercncloa of Obatructloa of 
the Pawgi of Gm Following OpcratioiM on 
the Coloa. J. Am. M. A si.. 1916. b%'U, 4S3. 

Ochaner believes that in operations on the colon 
the grentest danger to the patient comes from tension 
caused by obstruction to the passage of gas. He 
describes several methods by which the accumulation 
of gas above the seat of operation may be prevented 
as follows: 

t. Reder's method for cases in which the cecum 
has been removed and the ileum implanted into the 
transverse colon. The end of the ileum b passed 
out through a button-hole in the abdominal wall 
about 10 cm. beyond the point at airich the anaa* 



tomosis between the closed end of the transverse 
colon and the end of the ileum is made. .\ tube is 
inserted into the free end of the ileum which will 
permit the gas to escape which may accumulate in 
the ileum, until the entero-anastomusis has healed. 
When the drainage tube is removed the fistula will 
heal spontaneously. 

2. Incase the separation is so great that the ileum 
cannot be implanted into the transverM colon with- 
out tension, the free end of the colon is dosed, the 
ileum is anastomosed low down to the sigmoid 
flexure, and a rubber drainage tube is carried up 
through the rectum and the entero-anastomosis into 
the ileum, after the method of Lane, and stitched in 
place. 

3. When short -drcuiting for intestinal stasb 
(anastomosing the ileum to the sigmoid), the short 
distal stump of the ileum which remains attached to 
the cxcum can be brought out through a button- 
hole at McBumcy's point. This opening can be 
used for irrigation. 

4. In addition to the above the sigmoid may be 
divided just proximal to its anaatomoab with the 
ileum, and its proximal end passed oat through a 
button-hole in the left tlank, thus draining the ex- 
cluded colon at both ends (Gillet's proccdttie). 

5. Incase the descending colon has to be removed 
for tumor or diverticulitis, the colostomy according 
to Gillet's method can then be placed at a point 
corresponding to the distal end of the rrmslning 
colon. (Under these cooditioos, or the conditions 
outlined in the preceding {Miragraph, the stump of 
the ileum attached to the cxcum may be closetl if 
desired, so that the colon will be drained only by the 
colostomy.) 

6. Where a portion of the sigmoid must be re- 
sected but there is suflkient left for a direct anasto- 
mosb to bridge the gap. Gibson's method is tlM 



lVTi.oviTfnv\|, AB?m»%rT nr ^rRr.FRY 



of UMCt. A ntbtef lubc CAffted up csMnmcnii wm io cktcnnuie iM vuuc ui njrp9> 

ilH««li iIm iMM aad iieim b MwM iMo tito ctiorif •! ■ipwli m a l i ilB l i rn ii i of th< hwA 

Mnr MHMBi of ilM 4«emli« eoloa. aad tMi b aad MpidiVjr ■• lo lis mUm « aoo-iponrfaMd ml 

iGii liv^lMMd iMo tW Imw MfMM, Md tW cfobs Cmipmt aplii f l o fl O W , «cc). 

iwvaraMMkynivt. Nwi niowhuil akrabw in d twy id vltiiii 

T. la «qr iy—tfoa oa iW cdoa la wWdi tlM two lo foar arfaaiM b a tolailoa ol aMfMb 

■■SMa b aal MMw Ite Iw caa abiaia Ikm paMMi kypacMorila of i.s (o >.$. Bacfllut tabtflb b 

of Ml pan Um Mat of opvatloa bjr mom tadi kflbd la • arfaato. For the Morilintioa of ibe 

aMiMa»ilMHdacited,iibalaaftvbtioplaco haadt Un v 



■• tako laia Um laaMa of Uw OKoai 
Ma, aad la ptm Oik oal ihroaali a 
Um abdoalaol wafl dbactly la froot 
«ydi tW iMoMiBi !■■ biM pocfor- 



lib 



laaMfortMft 



la 
of iWpiiaial 
•ltd lor dralaai 
a labt • cai. te 
iIm 0UH(k ikroarii a rfadtor tabo of tUffify bmv 
dbaMor, m tlM It kafi b doMljr. TW oatar tabo 
btaiand to tW coloa at tlw poiat of pcffocatloo 
la tadi a way a» to piifi baaaft: tbe laaar tabo 
b aoi pMttfalod Vf tbo ttltcbMi Tbt coloa b 
tiHa paMap tigbutjr Miian tbo pHltooeam op- 
poriu tbt flab woaad, Uiroagb orlkb tbo tabe b 
canbd, aad a lev fao attant unite tbt Mriioataai 
aad tfaaavonali laHlk Makiaa Icokaat naDOMiblo. 



_ Icokaft: 
bt adbid for loiNiixbrii, or for 
Id load ar ol lata tbt ooioa* 
AtaooT 



lOMdis aft Mptrior to tbott oMolaod 
wbb lodlao tiaclaio. A batb of 6 to 8 adaala^ 
danlioa la a loltttloa of i^ of tbt aatbor^t ledt 
p iifoat i culture of digital or tpldonaal mioobti. 
Htpttltioa of tacb batbt ha* never caaitd any alttf 
atloa fai tbo tUa. 

Tbt aatbor baa abo emptojrod tbb iolotloo in 
bvafe and dfoniaf of orouad*; tbt rttalti obtalaod 
bavt beta toptrior to tbott ohtalatd from tbt am 
of Dakin't fluid. Tbt autbor rtcammcoda tbo am 
of bypocblofite of magnetla io obttotrio at ba 
iaaooalgr b abtolutc, aad it* bacttfkldal powor 
coaildtrablt. It b tatily aad cbtaplljr nrwaitd i 

^w» A* aaaaaaa* 



A.t 



CAwpib Mier Aiiti«|Nb bd ffbdMr Wi 



ofPkotbW< 




L. loia. p. 90S* 

Cbatoa*t amibod of preventing pott-optr atl v o 

1 loaalta, b at loBooro: 
iba optalaf lacWoa bo allowt a ctr- 
of rampbarattd oB to flow into tbo 
tita plaoaa tbt pothat la tbt dtflaitt 
poriiioa aad altar covoriag tbo vtatial 
a doaaa or to latpnattoaa, pfo- 
toctho tafjrfcal coomrmtm being placed to abtorb 
tbttacamofoByflaJd. 

Caaiphanlad 00 ^q*t— f obtttactioa of tbt lyai- 
pbatic cbflHHbt cbtcka aairfaiiaatioa of hnvf, aad 

it p£qrt aa 

Tbiot baadred cubic 

of I ta 100 mtaiib caa bt i^itctod 

W.A. 



s. kUm. Ckk., ioi6, c, IS. 

Uaaun poinu out that Gebtit, WQaH, aad olbor 

nave used and reoommeadod tbt att of 

it in the tr eatment of primaiy infoctloaa 

Wiigbt, Caml, Dakia, Dtlbtt. aad otbon. Whb 
Nfara to tbt bacttrlobfical caariaotioa of 
wounds, in bb opiaioa, al rdliblo badorioloiical 
mramiaiilnat show that aa offactifa dtaiaf ootloo of 
bx mtoat of latbtptiri cuaot bt at- 



any awrt tbaa tbt vaglBa can bt fretdfrom 
k flora by Uvafta. 




bt 

of 



AflVnC Ain> AimSIPTfC tOROIST 



llllllMlll til 

Aatbeptk dfortt naot thtrefort at 
diredtd toward lupportlag tbo 
tbo 

^f^fy fa nb y tk l i tbaa by T*tiri ^f * *ataiif Iti 
bt adadtttod that tba aa ui t ioa i oflbru amdo la thr 
trtatatat of patrptraj JaJactJoa to dbcawoi a treat 
batad oa a tbtrapy aeeonUag to 
ttaadBoiatt bavo i b t daitlj r f alltd. 
AO attooipu to dblodli MUaachad fSBW from tbo 
wouad bavo faOod, boeiaM iKma faapbmted la tbo 




tbtot, caa bt kflbd by aatbtpiica oaly 



Tbt 




Bat 



baanplacadtbo 



ait of olkaHat bypocbloritet bavo 
la tbt trtatawat of Infcctod 
tbty ant caattic aad 
bt atatralbtd or 
Oa tbb aocouat tJw aatbor 
bato by aa iadtferrot baotb 



bat tbdr aatural rmbtlac | 
tbt actloa of aatbtpnok 



W.A. 



AlfiBSTHBTICS 



A. 0.t 



dafawa for tbo 
bvpoddoritt that It b athha 
Tat priadpol aba aoai^ la a 



of 
m DOBMnuwgib 



/• Mti., 1916. ifl, los. 
Tbt aatbor 



tbt oio of oat f oaitb of 



GENERAL SURGERY — SURGERY OF THE HEAD AND NECK 



half to one per cent lor oerre-^ilockinc. and a five 
per cent solution for gpinal ■lurethreia. 

The tcalp may be aagethrtbfd Iqr infiltration, the 
fifth nrr\*r aftrr it leaves the tkull, the anterior part 
of the net k \>y injecting aloos the posterior border of 
the «trrnoma*tuid mtaede, tne upper estrenUtv by 
t>t«Hking the brachial pleinit between the scalenus 
nietlius and anticua. In tbe chest and abdomen the 
lateral nerve-tninks can be blocked as they come 
from the intervertebral foramina. The perineum, 
rectum, and urethra are most satisfactorily blocked 
by sacral amrsthesia, the spinal puncture needle 
bang passed up the Sicral canal through the ter- 
miniu opening and m to 30 ccm. of a one per cent no- 
vocaine solution inject cil. This produces complete 
ancMhesia in from ten to thirty minutes over the 
pcffncilrrginn. including the scrotum, rectum, penis 
(except at its base), urethra, bladder, prostate, vagina, 
and cervix. 

Spinal anesthesia has been used frequently and 
with apparent safety, from i to j ccm. of five per 
cent novocaine being injected in tbe lumbar region. 
In acute abdominal conditions, in prostatic work 
where sacral anesthesia b not satisfactory, or in 
any intra-abdominal condition that would be made 
worse by general anesthesia, spinal anesthesia is 
indicated. In fractures ol the lower extremity it 
has also been found satisfactory. 

E. K. AansnoMO. 



SURGICAL IN STRUM BRT8 AND APPARATUS 



Orr. II. W.: A New Soto* Bnem tar cbo Ra«stloa 
Treatment of Scoliosis aad for Other Piirpoass. 

Am. J. Ortk. Smri; 1016, dv, 446. 

Tbe author presents a spine brace designed for 
the rotation (Abbott) treatment of scoliosis. It 
consists of a wide and strong pelvic band with a 
vertical cylindrical rod running up the back. The 
rod may be straight or fitted to the back. At 
present he prefers it strai^t. Over the rod he 
drons little coUara corresponding somewhat in site 
and position with the vertebre. These have toothed 
edges so that each fits securely against its neigh- 
bor in whatever position they are placed. Some 
of these collars carry "ribs" which may be placed 
at any level or in any position or rotation desired. 

In this way pressure may be exerted tipoo the 
ribs at any point and to any degree. Near the top 
he has two collars carrying special pieces for the 
support of the shoulders. Having placed all the 
parts in the desired position he turns a nut down 
securely against the top " vertebra, " and the entire 
brace is securely locked. Advantages daimed are: 

I. Positive rotation correction may be obtained. 

7. Complete adjustability with actual alteration 
or weakening. 

3. There is no constriction of the chest. 

Pmur Lawm. 



SURGERY OF THE HEAD AND NECK 



HEAD 

Paua, M.: Mixed Tumors of the Face (Ucbcr Misch* 
geschirulste tm Gcsicht). Tr. XI North. Smrg. 
C»mg., 1916, Goeteborg, July. 

The author reported 76 cases. In these tumors 
there b a benign aiui a malignant stage. On an 
average they become malignant about six years after 
the onset. Recurrence after the operation is much 
more frequent than supposed, $3 P^ c^nt. The 
average length of life after the operation is only 
two years. The genesis of the tumor is still in 
doubt. From his specimens and preparations the 
author concludes that the parenchyma of the tumor 
is of cpitbdial origin, as gland formation and cor- 
nifiication take place. They probably arise from 
embryonal rests here as elsewhere. L. A. Jdhmkk. 

Roy. M. and Martinlcr. P.: Trvatmrnt of Injuries 
6f the Face and Jaws .Sustained In War (La cura 
dcUc (crhe di gucrra dclU rtgione nMsceOo-fadale). 
Amm. ii odcnt, 1916. i, 343- 

The authors have made a prolonged study of 
injuries of the maxillary region occurring in the 
course of war. The retention of fractured frag- 
ments b of much importance for consolidation. 
The methods of retention in use are three: (1) in- 
traboccal, which b cither simple, if the fractured 



jaw only b used for anchorage, or intermaxillary, if 
the opposite jaw b utilized; (3) external retention 
by bandage and sling; (3) bucco-extemal. All the 
retention appliances used by the authors have been 
intrabuccal. 

An intermaxillary retention b necessitated when 
the fracture occurs on the ascending ramus, or at 
the union of thb with the horiaootal ramus. In 
these cases the mandibular stump b dbplaced to- 
ward the fraaured side and a holder for the upper 
and one for the lower jaw b necessitated. 

W. A. BaxiarAJt. 

Imbert,L~andReal.P.: Ilypermyotoolc Conscrlc- 
Cioa off tbo Jaw* in War Wounds (U coeiiiiionc 
dcOe mssrrflf per fchtr di guerra e i §uak rapporti 
coo^ stati ipcrwielonki). Aum, di s rf — f , 1916. 
i.341- 
After a study of the prevalent coodltioas the 
authors are convinced that the syndrome dcKxibed 
in the classical textbooks of surgery imder the title 
"Constriction of the Jaws" does not corre sp ond 
with the syndrome which b observed in actual prac- 
tice. Their experience was with the isth French 
Legion of War, and includes about 150 cases ob- 
served. 

Bony constriction exisu 0^ anapdoanQjr; 
dcatrifial constriction b much more fn^Mnt, alM 



INTERNATIONAL ABSTRACT OP SURGERY 



irtctlMi wMdi nty w 



M abMi •» pm tarn of iW caMi kv 

' CMMdhirMMlWCtMn 

rfK» ifcr 1— iffclldM it 



itkwIaUoa. 



illi 

li 



liCtiMI 



Mdbi 



vtffv m 

M fc yH tf iM faumalbw 

» Madcr ibr iuiiim». 

ioay. ff«c AlUwvcli iW 



Jrat M t^tyly todtod Uity c m •arfly bt opcMd 

WHll ft WOtfc^pWMf ptOVMM IM piOCMB W ilOV 

•ad piittl. Ihaf Mv ruiijr MMdatcd vMi 



Mbw ilutf iImv b a paialW b»> 
aaalaooairac* 



livfraci 

|««M CHMiktfMi «f iMt yad la war 

lanr «f iMbi diar Imtmf, Inm tW rapMiiy vUli 

•Well boili pimti ailM aad ia tkt iaalioa ct 

iW aiiHaiit vMdi bwoaiw awa rabdllow tlM 
laaair ii it aairwud, Bai. aaUkr thr myocoay 
ol tat laibt* aQiinoaiii caatlifciioii o( ihr >aw« hat 
a btataa pfanatlt. W. A. Bbsxkax. 



.A.C.t 



for lb* TraataMBt af 

BHt J. Smtg , 1916. kv, 64. 



TW aatbor npatu « aambcr o( iaiciatliM Jaw f*****" 
faliaifat aad tbtir inaiawai . acromnankd by pimo. I*^'*™^ 



af tf^laaett mtd 10 utM ia coffrltctiaf 
ibt i hl i w i i y. Aanag tbc latter ar« tbowa tbt 
Mtbad of wifi^ Ibt itttb wbta oat Jaw It iplfaMad 
•gaiati tbt acbar fai cattt ol (raciurv. aad aa as> 
tcraal valrtaittd nKai for tbc mom parpotc. 
Wbiaa tbt loaar jaw wat ibot away from tbt 



la caaiidiHn MMfled liaataiaat of 
Ibt abova focion mate bt doarly borat 
Tbat* cattt wllb obtiniciioa to tbt oatftev af irfd 
Ikaai tbt VMMildtt are tbt most Uvorablt far tar- 
pkal iaitrfwcat tbt latrtvrm ricuUf Bffait caa 
bt itUtttd by vwtrkvlar paacture aad, la cattt of 
■BJdiadc aitaiaglth, aa ofiportualty it oiitad for 
inc litltctiaa af Floatr't tmua duadly lata tbt 
watfkalar tpacat. Ia catt tbt aaraud aotlalt for 
tbt abtorptioa of tbt dab! (tbt paccMaaiaa graaala* 
liaat aadolbtr aracbaoM vOtf ue bladtcd by tbt 
prodacu of iaJtcrioa, toifHy tifordi vrry littla 
itlitf aad b aat iadfcattd asetpt (or tbc toiroduc- 
liaa of ttra. The two type» of ctttt aMy bt dif 
ftrcatiatcd by a lumbar iojectioa of pbtaoMdpboar 
phihalcin which fthould tpptar in the ariatia tea 
minute*. 

Tbt aalbar briefly lefcn to tbt varioat targlad 
p i uca d iut advocalad for the tiaatawat of laiiala 
gitit aad rclatct bit eintfi a n c a aritb iIm Hayatt 
optraiion (or draiaaft of tbt potltrior ditera. B» 
operated upon two cattt of poeaaiococcat iitfectJoe 
oae of which died oa tbt teoth, tlw olbtr oa the 
tidrd day, aad oae of strepiocoocat lafootioa arbkb 
died twciife lawn after the optratioa. Hb as* 
dott BOt load him to rcfud Irit operation 
avorably. Oaa catt ot mrningitb foUowbg frac- 
ture iovolviaa Um arfdd b foata optrattd opoa by 
tabiem porai deoompiattioB with draiaaft prtaaptly 
r tc o irt r e d . No infecting orgaaita was growa oa 
caltartt from the fluid. Twt cttt had a aurhad 



tacoad bicoipid to the ttoaad bicatpid of the other 
iMt. a tplai wat attd with a Jack a 



tcrew altach- 
af wbicb the fractured oadt could 
fticad apart at the cattae forawd, tlutt 
ladog tbt ooaioar of iIm Jaw. 
Olbtr iplMa dtpfctcd ware a prtpbylactic epiiat. 
a palota iplot. aa tecSatd pbtat andt to retain 
iIm laoar Jaw ia alaca. aad aa devalor cap epUoi. 
lai Hny t d far a Iraciarr at the aMdiaa Hae aad 
aaitrior to the im molar. O. L. Oaarium. 

r. H.d 



Kendg; optic diakt byptntodc: otU cooat of 75 
(all potyaadtan) ia tlw apiaal Md; giobulia reac- 
tioa priatat; tagar abtent. 

NaAdger't coadotioat are: la gtatn 
infcctiooft, freqoeat luaibar paactoiat with 
withdrawal of 10 to 50 caa. ol flaid bava a dtiaite 
value. If there b lacrtattd ialfacnudal 
aa shown by choked diak. iotraveaUiealar' 
b bttt nHavad by the Havaca apt ntl o a or by a 
corpotcallotampunciurr. l( the fiwaattd prtttare 
be due to (aulty abtorptioa. little caa bt cspociad 
from any operative procedurr. R. 




pared la 
dat lalbt 



vatcakriiy of tbt OMatt aad the 

takca placa dbactly lato tbt 

FMlMffowrv. the otatial otrvoat 

10 the dbact actiaa of 

pNMtciive e a b tiaa c tt fonotd fai iIm 

to tbt iaitctioa caaaoi iad 




tbt iaftctiao. la- 
of fhdd by tbt 
if ibb iacftatt bt ia aaoat of 
tbt abMrpiiao, ar If tbt abtarpiive cbaaadt bt 
Mackmi, tbt hfitaii ia ioisacnudal prtttart alaot 

ifaii 



/Immvmum. B. F.: Brain Injurtoa. Am,I,Smtt 
1910. ixs, ^54. 

The author offers tool 
ical obttnratioat oa tlw 
of tbt otatrtl acrvoat qnteoL The 
aMia riotdy altachtd to the craaial 
tbt batt b Bwrt Hktly to be tora ia batal fiacti 
iatkottof the vault. In rhildreo, 
attacbtd to the Miturrs tbaa 
attradaral bcaMMflMte b more ttkdy to bt 
10 oat baat tbaa ia adalta. Ia the apiaal caaal the 
dara b aat aitadwd to the wtrtebni bat btaa a> 
a loag tiaMic tabt rapaMt af diataolioa nor 
awlly tbtta b very litUt tmaet b a wa ta tbt dura aad 
pia aiadHMld: bat il b ja aaattd by aocamulatioa 

Tbt otrtical vtiat ta4iiy for tbt awtl pan iato 
tbt loagllMdiatl aiaoe by way of tbt bcaaa lattraltt 



GENERAL SL'RGERV - SIRGKRY OF TIIK HEAD AM) NECK 



which attend outward ooe-haU to oitr mi. a ux,„i mc 
lonritwiiBal fimire. 

TM pacchionUn bodies, whkh are extrn&ions 
from the arachnoid, cootainiM cerebroapinal Huid. 
are thrust into the laouye. 'Hierefore the dura in 
thb legion b very doaely attached to the brain and 
oooiequently it* teparmtioii in operations or injuries 
b attended by acnoos hBmorrhagc. the cerebral 
Taiaa being torn in the proceaa. 

The cavernous and petrosal sinuses are liable to 
injttiy in basal fractures; blood from the petrosal 
enters the subdural qtace and escapes through the 
ear. 

Normally the amount of cerebrospinal fluid is 
small except in the cistenuc of the arachoid at the 
base. In case of brain injury these act as a water 
bed for the brain. The common symptom of head- 
ache following brain injur>'. however slight, is ex- 
plained by the crdema producing dural tension or 
diatentioo, the dura being supf^ed by the Mth 
nerve and extremely sensitive to pressure. Delirium 
and mania are due to irritation, stupor and coma to 
pttniyuM of the cortical centers. One may follow 
the other condition or both occur together. Thus 
early nnconsdousness may be followed by severe 
headache and later delirium, or, as in cerebral 
iMemorrhage, delirium may precede the unconscious- 
ncM: in the latter case, if there is an alcoholic odor 
to the breath, the mistake of a diagnosis erf alco- 
holkm may be made. 

Focal symptoms depend primarily on location, 
bat also on the character of the injury, which occurs 
aa four typea: (i) laceration. (3) concussion, (3) con- 
tiakm, u) compression; one or all of these may be 
present in any given case. Pure concussion, how- 
ever, b now regarded as very doubtful, it being 
genmlly believed that this is nothing but micro- 
scopic contusion. 

The phenomenon of increaaing blood-pressure in 
cases 01 compression is explained on the theory of 
vasomotor stimulation. Tliis takes place when the 
intracranial pressure has reached a point where it 
shuts off the arteries to the brain, causing anarmia, 
which stimulates the vasomotor center and in turn 
produces a rise in syvtemic blood-pressure which 
overcomes the brain anjemia. 

The choked disk is not the typical form but is a 
dilatation of the veins and contraction of the arter- 
ies. It b often transitory and frequent examinations 
are therefore necessary. In cases where doubt 
easts aa to presnire, lumbar puiKrture may be of 
much value and b safe except in cases with very 
high blood-pressure. In these there b the danger 
that withdrawal of the fluid will allow the meddla 
to be crowded down into the foramen magnum. 
The pressure should alwasrs be meamired before any 
fluid b withdrawn. In cedema following co m pre s - 
sion or contusion relief may be afforded by spinal 
puncture alone. 

Depressed fractures of the cranial vault, if in- 
volving the silent area, may produce but slight symp- 
toms and often appear trivial, but owing to the 



• -> ->ri|uriir, a* epilepsy or psychoseSt 
t): o[Krratcd 00 as a rule. In cases of 

iuiiiiitirwM" - vcr slight, the patient shoold be 

cnrarally « od any signs of inrrf ring com* 

piwring (ou I :«iiuwn by the rise of blood-praasore, 
slowing of the pulse or respiration, rhinjig in the 
fundua of the eve and increase in cet f ibr o ap i n al 
preaaure. are indications for operation. SumoU 
treatment in cases where there are no localmng 
symptoms or signs b subtemporal decomprewJon. 
The mistake must not be made of waiting until 
positive signs of paralysb or beginning paralyib 
of medullary centers appear, as shown by increase 
in the pulse-rate, lowering of the blood -pressure, etc. 
In cases of fracture of the base, the author b of 
the opinion that decompresaion will afford a greater 
percentage of cures than expectant treatment. 

IfoaAce BixwBY 

Grey. E.G.: .Studies of thcl.oc«liantion of Garabel' 
far Tumors the Cranial Narvaa. Bmii. J»kmt 
Hopkins Uosp., IQ16. xxvt, 251. 

Thb study deals with the significance of cranial 
nerve involvements. It U based ufMn an anolysb 
of the records of 6^ cases with intra- or extracere- 
bellar tumor confirmed either at operation or 00 
post-mortem examination. .\s previously stated 
by the author, the material ha.s been clrawn from the 
records of a series of several hundred patients with 
syndromes of cerebellar disease in Cushing's neuro- 
logical service at the Johns Hopkins Hospital 
previous to October, 1012, and at the Peter Bent 
Brigham Hospital since that date. 

The salient {M>ints gathered from thb experimen- 
tal study are as follows: 

1. Since anemia in cases with intracranial tumor 
b usuallv a dUtant symptom due to a scoondaiv 
internal hydroce|>halus, it has no appreciable signi- 
ficance in the localization of the ncw-growtltt. Un- 
cinate g>'rm symptoms may appear, secondary to 
an internal hydrocephalus. The sense of amell waa 
affected in alxiui 7 per cent of the 6j certified CMCt 
analysed in this report. 

2. While chokea disc in itself has no appreciable 
localizing significance, since it b not infrequently 
noted comparatively early in the course of certain 
supratentorial tumors, it may have some importance 
in thb respect when it b aasodated with other tigt 
It has been the author's experience that the early 
appearance and high degree of changes in the eye- 
grounds, when they appear in company with some 
of the ao<alled cerebdlar sjrinptoms, are importaai 
con&rmator>' evidence pointing toward a siihlc»> 
torial localization of the new-growth. 

J. Very little reliance can be placed on an involve> 
mcnt of the third or sixth cranial nerve aa a guide 
to the side occupied by the new-oowth, in the 
locaUntioo of tumors in one or another part of the 
posterior fossa. 

The observations recorded in thb paper are in 
favor of the view held by many that the njrstagmiia 
seen in cerebellar disease b very frequently of oen- 



INTERNATIONAL AMItACT OT WUOMBY 




_„^ ^ _ of lit lyt mmdtm. — ciihr wiikiiiM te Mt auHwd aad U b 

-hitfyvviiiclitWcniMlllwwtl^pMibtloMr taunl to Um fPvvtk 

mkik iW flfM lanwd Mimfd Um ituMr A wiifcim of Um mmdm iMMnraiad by om 



b mUri io MMor mtmltmm, Itkm, hvvmr. twrilili Mrrt it ol vtry link ri g niicMc t U tW 
ilMf* It a diirito Md 



of tvmonlaoiM p«it or ModMrof Um 



SSToliW^te. ' •-■^y — ^ B,.^, O. J.. Mid DMitfF, W. ».i A RMorC of 

^TT*. . . r— fa—i« diiiUtLuL 1^ th« loiw u y Ohm of Wnm Ttomor. Bafl. y«*a« 

•y« Ml oilj lrf>ii|OMM|j 7ii7ilii il ii tbt bM B0pkim» Bmp., 1916. nvfi. au- 

•tfvMHid CMS of nAlMiofid tumor. Uht kovt TIm Mthon tuvc rrvicwod Um omoi of brote 



of nAlMiofid tumor. UHjr hovt TIm Mthon b«vc rrvicwod Um omoi of brote 

loblMr Init f-r*-**^ (■ (^ iomMMlhw of tvoMT la potteou who havo oMond tho Margkal 
MMBVbUitlMHMrioraublfoHO. Ttwdo- Mrvkt of Dr. Habtcd boCwoM SipUmbor 1. 1911. 



violin of Um 9fm hi wiliAi Bt«-flro«thB b ond Jaauoiy 1. 191 5; —dto tho pt oi i iB i 



viouoii 01 lat 9fm m omosmmt Mw«fro«tai • oDqjamwy 1. 1913;— quit— |"uwm» cw muwru ^ 

laMljrMMi prior 10 opmloa tlo« th«o coMt are coMldofMl for Uht pvpoto of 

la M^btoMoriol t— nn hMohoBMU of tho ifth oomaoaiii^ opoo mom of the problent iadfcalod. 

cnaial aorvt how •» lijinonihlfil '-r— ***** te Tho aothon alao iadlcMc tn ihb paper tho vahM of 



(«bhio tho poitorior foHo) wbM the eooM of the more coomoa dJignoetif akb. aod r»> 
tMMT lea hi OM leiiliiiiiiiiliM oa^ or the late a few eip a rbiif oa la the patholoijr aad dUhr- 



oiher. Sach a '—a—'— b tttohr oaly vhn oaiial dlaiBOib of braia tumor*, aad BaaOv 



the hoaHlaiefal cifhth (or aeveath) aerve b abo riao otapa ia largkal technique that have Ivivnkkf 

iaiaeaoed their moctality aad operaUve 



ponrift or a paraljrib of oae fadal acrvv ia CoadJtioBa other thaa trve braia taaMr wore ia- 
e» of thepoeictiaroaaialfoeBab etfoat pre- dadod ia the 70 caaca which form tho boob of thb 



fevideaccoftheeUeef thebrioa,thoacha report; i^. epoa dj ra d tia. p ai hj i i i M aiapi l b iateraa 
nnib appoam aoi iafreqacaihr hi ■iiMan arowtha. haaMohaficai eaoephalitia, a rarhaiddftit , cerebral 
Whaa the olAlh or the (ifth) aorvo of the eame 



or the (ifth) aarvo of the eaoM taberde. daral gaauaa, aad aaeatbai of the iator^ 
eide b aba oiecied, the dh^aoeb of a hoawJaleral aal carotid artery. Yet the evaiptoaM hi 



powth aMar he aMde. A ^malloaoble iavohm- ooaditioae sImuUtcd eo dooely taoee of braia taamr 
of the iiwieah aerve, oa the other head, b that operatioae were aeaaUy p ei f oraMd aader the 



dacipUve hi thb reepect dae, probably, to the rela* eup po eiti o a that a aew'gnnrth waa pr eeea t . Of 
of aonaal facial aqraMMtriea of thcae 70 caaea the nature aad poaitioa of the leeJoa 

waa oetabMahrd by the authors at operatioa or at 
'•fTBwth a eHfhl anaatcral aatopay la 40, orj? per caat; aad two a dd l lina o l 

certlaod 



of hoBiiat. whkh baa ap peared (or the caaea were certified throagh operatioae 

liaM hi coa^oay with pcaeral prtaeare symp- by QMhiaf . The wmahwag *8 patieau pw ee a tod 

I. b b dh ad fi either of a hooMlateral taaMr or, dafiaho ri^ aad aymptoam of braia taaMr, aad ia 

beafreoaeall^tOfaaMdhafrBwth. Whaahaariag, the great aiafori^y of bMtaacaa were operated apoa, 

aadv iiadkr cbcamaiaaeea, b veatXy iaipaiied or the operatioa, howovor, faOiac to diadoae the 

loai ia OM oor. It poiau toward a hoaMMloral ex- leeioa. 



of the taaMT. Sach a Of the 70 patieata, 6f were operated apoa. Ofthe 
b eaafbaMd whea cither the aeveath or 8 patieau not operated apoa, 6 l a f aeod op er a t ioa, 
the ifth aarve of the maii eide b abo alletted, niii had wirh iiiteMlTO inir"*^"T *«****■*«*—*■ »^' 



HhIml il appean, b aot a rrilahle folde to the 
aide oocapMd by a laaMr eitaalod below the tea- 




la the ward before operatioa. Sevoaty-oao aojor 

operatloaa wore perfbrmod oa thoee 6a padoaia; i^ 

Akhoafh vrrtifD b a p raa da e rt qra^aom of ^Ma eevoial potfaaie, oa a eecoad adadeeiea^aa 

■a aa rmapored with groertha eiploiaiory craaiotoaqr waa penoraMd eabaoQao^' 

hi the brafa^ it ha* ao ttBpredabb hr to a eabteaiporal daioiapraMlna Therewere6 

of the <MMea hi dealha oocarriai bel 



for the localHloa of the dtaaaeea hi dealha oocarriag betweca 84 hoora aad five daya 



part of the poalarier foaw. after operatioa — aa operaUve BMrtalfcy of S.6 

\ of df o an hri a aad dwp hada. aalaea per oaat. a .... 



The preaeace of d» « Mt l Mia aad dyahada, aalaea per oaat, a caae amrtaBty of 9.6 per ceat. Two 
they are vtiy amifcod, hi poihaie wkh aawoiarlal padaatt aabaagaaatly died to the hoepitaj, their 



a e o a r ce "of aariay , b ao ceatra- coadhioa aad aabeegaoat death beiag oaporeatiy 
e aefUMr b a reiable oalafiiiiBrriil by operaUve p ro cadm oa. lartad l a g 



of aa hapoadtof fvpfaatory aandyaie. Whea theae the total BMrtality waa 1 1 per ceat aad it J 

of the aMet etiih- per ceat reVMCtlvoly. There 



tiMy oocar, tbqr waaillaii two of the aMet euih- per ceat reipoctlvoly. There were 00 dcatha apoa 

bit lyaipteaM of iaiia- aad eauaoenbelar aew* the operailat table. 

frowthi. A aaaiber of caaea are reported by the aathora 

The ipiaal eotoMurj aerve b oaly rarUy tovohred to onaaldanihla dolafi aad acc a ayoayfan the atady 



(to bM Ihaa s (SJ^^**>) ^ taaaoca of the poeicrior are 




thb aerve b afected. the O aoao i B. 



GENERAL SURGERY — SURGERY OF THE HEAD AND NECK 



Whit*. A. H.: lUport of Cmm of Gl kwr ccM M i of 
UacliHit* GjmM. f^eifk U. J., 1916. Ux. 466. 

The author icpocts a caae of Micoma of the bnin 
in a patient agad tMit y oowi ytan, whose fint 
pUint was awnrda. iHiich beome pragrcMivieljr 



another symptom whkh waa quite prom- 
vas anoamta, first unilateral and thai bi« 
lateral 
RoeolfM ftaiwiiiatioBa weiu nagative, as were 
rspoatod WaHonmBB testa. With the ex- 
of iHgbt proetatUis, a left varicocele and 
Ms, the physical eraminatioo revealed 
Antisyphaitic meaanres were of no bene- 
fit. Ftom the sjrmptoms and findings, a diagnoda 
WM nuKle of interrranid lesion. 

The intercranial pressure, the choked discs, the 
uncinate attacks, during which the patient became 
red, or cyanotic and flushed, the amnesia, the 
annwnia, the lack of headache, and the lack of 
locaKriag motor symptoms, seem to point to a new- 
growth in the froototemporal regioa, and, because 
of the anosmia, probably in or near the gjmis un- 
daatus. 

This intereadag case is fully reported with detailed 
autopay findings, which confirm the diagnosis. 
The sarooma was of the mixcd<eU t)!^. 

Emq. C R oeiisnaa . 



of tho Brain 

ccrebro). Am. d kaip. 



Qwlraa. D.: 

CFttiro-Biizo-sarooaMi dd 
4* Smt J0s4, 1916. i, 19. 

The case reported occurred in a woman of jo. 
F.taminatioo showed the principal symptoms to be 
angaria; convergent strabismus; papillary reaction 
to H^ slow; thyroid somewhat hypertrophied; 
evidoioes of qdenic malafia; rotation reflexes ex- 
aggerated; BabinaU sigB strong; donus of foot 
also quite marked. No Kemig's sign waa present; 
deglutition was imperfect and she could not dose 
her mouth, which gave her an idiotic appearaaoe. 

The Waaaermann reaction waa romplrfety nega- 
tive. The symptonu increased in intensity from 
day to day. .\bout ten days after entcrinK the bo»- 
pital the patient experienced sharp pains along the 
vertebral column, also intense cephalitis. Lumbar 
puncture gave abundant dear flnkl. but contrary to 
the findings of LebebouUet (in a case of pia mater 
sarcoma) nothing was found 00 microscopical ex- 
amination. The Widal test was negative. The 
author believed that it waa a case of cerdiral tumor; 
the patient died in cona about two mooths after 
entering the hospitaL 

In this case the author points out that none of the 
daaaical symptoms of tumor of the frontal lobe were 
preacot. Tbie crphaHtit and vertigo are rommnn to 
all cerebral turoon, no matter what the location. 
The autopsy in the case showetl the dura strongly 
distended, correspoadiag with the left frontal lobe. 
There were no aahcKSoea. In the left frontal lobe 
and in iu posteriorpart there was a tumor the sixe of 
a small orange. The result of hi«tological examina- 



tion of this tumor showed that it was a fusiform 
■graofibrosaicoasa and ahadutdy typicaL 

The author thinks that surgical uucrveadon if 
made would have been without satidactoty result. 
In an examiaatioo of the literature 00 tlua topic, 
he has not been able to find anv aaroomatooa tumor 
of socb a siae aa that hsdsscvibcs. 

W. A. BasmiAM. 



Marchack: Cerebral Hemlss (Hcraisa cfrfbiaks). 
Fns34 mid.. 1916, p. 35. 

Cerebnl hemic may be distinguished as occurring 
either with or without subjacent abscess. In the 
first form the abscess must at once be opened so that 
it may not discharge into the ventricle. These pa- 
tients dmost all succumb to meningoccphalitis. 
But the hernia without abscess is of more interest 
as it is susceptible of treatment. 

Marchack thinks that the cause of these cerebral 
hemije b congestive cedema of the traamatixcd 
brain, and that the tumor proiected across the 
insufficiently opened dura mater b ecom es strangled 
and adherent to the ring. 

Such a hernia usually occurs within a few hours of 
injury. It is not due to hypertension because iu 
v(rfume diminishes only very slightly after lumbar 
punctures. 

Probably one-half of those with gunshot cranial 
wounds show hernia, eroedaUy if the injuy is in the 
right parietal region and even if the osatous bmch is 
small. In wounds of the frontal and ocdpitd regjkMi 
hernia b rare. 

In treating hemic Marchack has tried all i 
from ablation by the thermocautery to sii ^ 
pression. He thinks that the treatment of choiosia 
after a certain period to enlarge the straaguladBg 
ring, remove bone fragments, etc, Lavage with ?o 
per cent formol and compression. In the course 
of treatment patients show crises of Jackaoaiaa 
epOepsy, but repeated lumbar punctures caose them 
to disappear. W. A. Bwomui. 

IfBCK 

Pierce, F. C: Trauoiaa of tho ^ieck wad Spine. 
Smrg.CyiHC.irOkU., 1916, criii, jjj. 

The author diacnaaes ooatoaioBS and 
the back, nriuding aU thoae with a ( 
than one week and thoae which are 
by dislocstion or fracture of the apiae. 
are indoded with the nmias becMse of the <Bficalty 
at times ia diatiagniaBiBg oae (ram the other, par- 
ticulariy when the coatoaioa is directly over the 
spine itsdf. 

Of 758 cases r eviewed 177 were dassad as ooatu- 
sioas aad 481 as spraias. Of the 177 oootaaioas so 
per cent were located ia the huahar ragioa, t6 per 
oeat in the dorsal regioa. aad 10 per ceat ia both the 
dofsolumbar aad sacral regioas. In «o per ceot 
the location waa not specified. Out of 481 sprafaH* 
4S0. or 87 per cent, were due to indirect 
47 per cent of theae involved the 




INTERNATIONAt ABSTRACT OF St'RGF.RY 



Of «i 4w !• 



ilH MM mlM. C&nk^ 



Old al b«i i«o wtn Sm f am tedlMct 
It l» Iwawrtili to &nm a diMtect Hat btl 



UMM hi oolir fan tiM HfHMMa aad 
Al of Um back iajaifaa an fwqailhr 
by M n m aa nraipioaMt b«t tlw wvant 
Jaqr b ae iMB !• iIm dipia «l Mrvm 



y «f Um Ift- 



MWtty 

ittto2i 

picatad Inr A Mi 
an aad dMaafi 
faararlaapr. 
Giaatcara 



laa partad aff nMbHijr n ipft 
iW Mvariur af iIh l^iwy aad at 
r aMia. la 
araaiatlMcanaf 

Um liaaWllly ouy be a 



hilMidba 



teBMkiatibe dUf- 
tt aat ba an0Maiad aor 

In o^fw^t ftln^ tba patifwt 

ia adftd tlut a (ractufc amy ba 

baadiiat auiy prodaca a dia> 




tbc 



after auiort 

aad ba ghraa 

_ gyawailk 

Tba rnandirallnai aboaU be tiaated 

_|0I 

an ciiad abaadat tba vaiiaty af iaJariea aad 
' natvitk 



Ckmhmi U. 



«aaa. H. C.t Tbe Galcar 
J . lata. tv. 45J. 

Tbe aatbor acnpu it aa bicbly probable tbat 
foitar it dae to lack af iodfaw ia tbe ayMca; tbat tbe 
ibynid flaad caa be atJanlaiad tbroagb tbe ceaind 
to ghra ap iu iodine; (bat in 
m^ faraiaa pmaiaa dfculAiine in tbe 
hcfiatiil tbyraid adiirity wbicb in 

cause 
bi pBMil ba4y oridat laa la order to 
tba lavadha arfcmMuinL Tbyroid 
aalaipaMBt baa baaa abaarvad fai dl acate Inf cctioot 
bat h mpmUfy aarinabla la lartplni tabefcaloaia. 
Aa iaiictlaa fai a 

" ' to 




ttm^nlil 

luynau 

It Iran 
yaiyiag 



Ibsmid baaoaly 
feyCabidMdaalb 
Iva fai a foiiar bA)la praaa to caat 
bmftrapby. 

Tba vaiyfait typn af tbvnld aalaiiMi 
caloM foiiar to Otavaa* dHaaM an aaa, 
aaiy la dipaa aad lataaAy. Tba eafla 
«« aidaniair iNa task mstona (anrocaidkia) 
aad aharfd aivayt ba nawvad, tbaagik la tbe Int 
1aa aaqr caainl iba fakar. Tbe toiic 
af Gra n a* dhaaaa an tba naak af aa 
■as laynaa aacnuaa waKa oaaMMa 
tba wbole ba^y. Tbe fanible baatt-baat (pykao- 
caidb) ia tba nwli oa tba bean of tbe aacaaa 
af adnaala aiWiit fraa tba adnaab tbnafb tbair 
hgr vayaftbe bnia via tr 
tbynid tecfiiioo 





Iba oaiput of Bcrvoaa activity by tbe ceatral ■»> 
vaai Man wUcb ia tara atimttlatea tba tbynid 
10 aifl fnalar activity caoaiag a vidoaa cfida 
wbkb aratt be biokaa altber at tba fbcaa of iafac- 
IT at the tbrnld by t by widactomy. U tba 
of Gravci' dinan be undue aervoaa or aMa* 
lal atrala. tba oaly way to brrali tbe dide ia by 
tbyroldactoaqr. 

Tbe aatbor ghraa aa iatemtiag deacrlptinii of 
tbe ayaniona aad aigaa of tba Jariplaal type of 
tbifitad wtaiicatioai aad aa^ibaiian tba ia^Kirtaaoa 
of a aaardi for onderlviaf onaial caaan. aaparially 
la fbb of marriafeable afe. aad for pnarfbia fad of 
iafaclloo. Th)rraid ealantrmmt anoriatod witb 
iadpiaat tubcrcukab b a (>-fw Irraucotly aaea aad 
IBBM always be ideatlfied. Tbe dWiactlva poiau 
ia iWaannaM an pointed out and tbe comet treat* 
awat H fivea aa reat in bed. out<«f-door ttfe, over- 
feedina and tanll doaca of iodine. 

In tbe adoleacent tvpe tbere b tbyroid 
ment witbout any tosoc t3ra^itooia (a 
hypc r tropby); or tbe border line Gravaa* 
with loea in wdgbt; or tbe beavy type aeea cbiiHyia 
boy». It b usually acconpaaied by acae, tbe iataa> 
tinal tract being tbe oaderfariac caaae. Operative 
interference b not advised in the adolc scent type. 
A type termed **cokl Graves'" b aext dncnbad 
which occun in women in whom coastipatioa b a 
known factor and the whole mm^MoahOMaplai b 
referable to intestinal stasis. Rest, botb pbyrfcal 
aad nsental, with proper nowrjabmrnt and attcalioa 
to proper cttminatioo arc the chief factors in correct 
la bypertoous asaociated with old 




coOaid goiter then basoaUy ao km of weight bat 
tba baait beat b irregakr aad forcible. TbebkMd- 
any run from iSo to aoo nuas. of aMratiy. 
ly givn ptompt relief to tbb dan of 
bat tbtHiM ba aadaitakea oaly afkar tbe 
-masde bn baaa pnpady sapportad by digi- 
I alb. 

The author advocatn giviai cbOdrrn living in goi- 
ter regioBS who an fodif tbnagb puberty aaudl 
aawuau of lodiaa oaoa fai tbna noalba. To pnf- 
nant women alao it b advisable to gha aanB aanaau 
of iodine (iva dropa of tbe qmp of tbe lodhw of 
iron) one aiootb out of three. 

Tbe treatment of Gravn' dbaan aa givca in detail 
by tbe aatbor may be bde^y oatttaad m Mkoim: 
Carafal aaaicb by evenr kaowa asaaaa for a paaaible 
focaaoflaiacdaaiaaayngioaof tkabody. Ifaacb 
a focaa ba foaad, reaMva b; if aot, dfaaiaau tbe 
prodacu of bactarbd dacanaaaitiea bi tba iateatlaal 
tract as far M paaaible. 1\yaMl (fhra gntaa), oae 
pfatt of bauanailk daily, UtUe or no neat, aad 
vsgatabln giiamiiiiily b tbe roatiae. Tbe aynip 
of tbe lodiae of boa, oae to two nbriaa. or paiayag 
tbe akia tbe dn of a qaaiter wbb llactan if iodtoe 
b oiad, witb dae reaard to a poadbb famaaae of all 
bad lynptoaai doiiag tbe an dkafin a If. alter 
«M aaaatb tban b ao liaptiieaniai, aaigfcal later- 
fanan b ladkaiad. 

For aaonarfal sarfny bi Gnvea* dbaan. it U 



GENERAL SURGERY — SURGERY OF THE HEAD AND NECK 



Decenary to know the ability of the body to neu- 
traUae add waste producu of metabolism. The 
respirat ory center icapooda vcnr ottickly to incrcaaed 
acidity in the blood atreaaa; taability of a patient 
to hold hit bnaih more than forty seconds is taken 
as the limit of safety regarding his ability to neutral- 
iae adds. A pulse-rate of i9o while in bed, a de- 
gree of fever during the day. and signs of lowered 
alkaline reserve are contra-indications for i m me diate 
lobrt tumy. Two to ten weeks are allowed to paia 
under treatment by the following milder methods: 
injixtion into the glai»d of 5 to lo drops of so P^ 
cent quinine and urea solution, the injection of 25 to 
50 crm. boding water, and ligation of the superior 
thyroid arteries and their sympathetic nerves. 

In severe cases operation is d<me without the 
knowledge of the patient that it is to take place. 
It is performed under full amrsthesia with as little 
trauma as possible, after thoroughly blocking the 
tissues to be handled. Four-fiftlu of the gland is 
removed; in no case has myxcedema followed the 
operation. 

Patients with localised adeiKMna are advised to 
undergo operation as soon as thdr omdition per- 
mits. In large colloid goiters compressing the trach- 
ea, the lateru attachments of the posterior parts of 
the ghmd are allowed to remain as a support to 
prevent tradical collapse. In cases with high 
blood-pKSsnre showing marked myocarditis, digi- 
tals is flven before sikI after operation. Post -opera- 
tive rest is insisted upon in all cases to allow the 
tired nervous system to recover. 

Ulth the treatment as above outlined, the author 
daims 95 per cent cures in patients presenting 
ihcmsclvri for treatment the first two or three 
months of the disease. This percentage drops pvo- 

tportiooately to the amount of damage done to 
vital organs by delay in seeking rdicf, or incorrect 
diagnostt. E. FisaatL. 

\ WUaoa, L. B.. and Durante. L.: rhangas la tba 
Svpcrtor Orvical Sympathetic GnatUn Ro- 

' aaovod for cho RcUcf of Eiophthalmoa. J. 

M«i. Reuarck, 1916, zxxiv, 37J. 

The present investigation » based on a study in 
. fixed tissue of the pathologic changes in cervical 
\ sjrmpathetic ganglia removed at operation from 
^ 16 patients with hyperplastic toxic goiter in the 
Mayo dinic, from December 17, IQ12, to Dece m ber 
ji, iQi$, accoffdins to the technique described by 
C. H. Ma3ro. Within this period sjrmpalhectomies 
were done on S4 patienu, but in 8 instances the 



spedmen other did not contain ga ntfnnic 

or the small anaouot therdn was needed for 

[Ouriaation in the fresh state. These are not 

flMteded in the present study. The questions to 

be determined are: 

I. Are the cervical sjrmpathetic ganclia in hjrper- 
plastic toadc goiter a seat of demonatnibte histologic 
changes? 

: If sadi histologic changes in the cervical qrm- 
p.ithrtic gaai^ am, b there a rrialioaship be- 



tween them and the clinical qrmptoms. on the one 

on the other? 

J. If histologic changes are not demonstrable, b 
the apparent absence doe to faulty techaiqae or to 
the fact that the S3rmpathetic ganglia have rec dv ed 
only impulses, which have Idt no trace in their 
structure? 

The 30 ganglia constituting the material on 
which the present study is based were removed at 
operation from 16 patients with hvperplastic toxic 
goiter. From 3 of these patients the right superior 
ganglion only was removed, from 3 the left superior 
only, and from 11 both right and left superior gan- 
glia were removed. In 5 instances the right or 
Idt, or both the right and Idt, middle superior 
ganglia were also removed. Small pieces of g»n |^ 
were examined in frozen sections of the fresh tissue 
immediately after operation by the method de- 
scribed by Wilson. 

The remainder of the specimen, or specimens, 
was fixed in 10 per cent fonnalin, and reserved for 
subsequent examination. In all, 35 ganglia from 
34 patients were examined, dther in sections of 
fresn tissue or in sections of fixed tissue. 

Each ganglion was divided transversdy into equal 
parts. One. the superior part, which contained the 
majority of the afferent and efferent branches, was 
further subdivided longitudinally into two parts. 
One of these was used for silver nitrate impregnation, 
and the other for Flemming's strong solution. The 
inferior part was diWded transversely into small seg- 
ments of a few millimeters each. Some of tbcae 
were used for staining with hematoxylin and eosin; 
some with Weigert-van Gieson for connective tissue; 
some with VVeigert-Luden for myelin; some with 
Hdd-Nissl for distribution of chromatin; some for 
spedfic fat , iron, and pigment reactions ; and some for 
silver nitrate impregnation. All preparations were ex- 
amined in serial paraffin sect i on s , except those cut 
frozen for the study of pigment. 

From a critical review of previously reported 
obaervations, from the authors' obsenratioas of 
control spedmens not herein detailed, and from 
thdr study of the spedmens from the 16 cases re- 
ported in this paper, they present the following 
summary which they believe to be a fair ■***tTwm 
of their present knowledge of the lesioas of the cer^ 
vical sympathetic gan^ in hjrperpbstic toik 
(exophthalmic) goiter: 

I. The oelb of cervical sympathetic 
from patienu over 40 years of age, and 
thougn rarely, from those yonnter, aajr 
hyperchromatisation, h ype f pigmeat at i oa, 
to^nis, and atrophy in minor degrees, 
dfignitnl "cell senility." but due to arteriosdero- 
da, Tronic tonrmia, overwork, or other factors 
wlrfdi cannot be acatratdy detemiBed. Of the 
16 cases studied, only j were over forty years of 
age. Of these, » showed lesions of the gSBgHoa 
ceUs far beyond those seen in any of the 
There was oaly oae case in which the 



IVTKRN'ATKIWI. AI15TR AfT OF KrUflFKV 



wTfv oi MKn ■ %iimtwf%wt mtmk tkvfw ■• lu navr po'* 

Milled iMr mpliMiiiw bgr ''tMlky." lo tl^ 
paikM, «Im irat tmtf hmt y mn «f ift, iW mfy 



Iki 



l«bt 



Iww alUr dtjtli, 
Mortttwy 



of tkt 




mort tlua (otir 
Um moM fovorablt 
sQiolytk 



TW iMfHa tnidM to Urfi 
vkUa ivt aiaalM aflcr ra 



dl ftscd 
from the livtag 
Mom of Um oontrol motcriml from a»> 
ind willrfo Umt Imm alter dcotk. 



y. WWIt VM CJMOo'fc lUiB it valooblt for §«»• 
wm liitiolotic diuAi oad NM** stain for iIm uvAy 



of oailjr r li rnai a tiii t^aT^^T*. tbe uaa of FtitffH y 
G^li Mid Ltvaditi*aaiaiaabi«p0dally to bo looooi- 
aadad lor iW atodjr of dotaib of late ccU d«if«e- 
tktt. TW aw of Sodaa in la tW difloraotiatioB of 
wlpfaamii aod of Wdgen-Ladea'a atala for mjro- 
Kb it alao iauwrtoM. 

4. It arodid appoar from the authon' ciamina* 
lioa bjr iIk OMtlwdi detailed, tlHU definite hiitologic 
I do occw in tlw ccnrical ajrmpathetic 
in kvpcqilaatlc tonic (eaophtlndnUc) foiter. 
y TImw Uitoloiic rhantw oonaiit of varioot 
of dcMMratioo: (t) I mwwi i n i inatii a fion, 



of tlw 



(») itiiMiJgnianialiiMi. (3) caioflMtolyria, and 
(4) alfophy. or ( 
nar * t >< «l la. All < 

wWck. if 



(5) 



in 
to iJm 



ooanlMo dattractioa 
L KotaO 



nranular 
of tocae aie bat 

wuptewnptodi pr oc eed 
1 of tba ff**" ceUt 
of tbesangUoo odbin any of the 
were to c o n i plet aly dcatioyed aa 
to lendor iapioboble tbeir racom to normal under 
favorable MWMl l i io iw Tbcio ii aooM afjdinct that 
in fMMpa Irani caaca cUnicnll^ in^no'vod aooM of 
the cwa have; 

the partidly 



ve poftitily or vmVjt looovoiod. 

of ths nuMlin oonlnin oUa leaanihlinc 

hr dUraStod cdb in the naSnof 



7* Acconpanyins the bbotc advanced 
the nantfon CMt are t^tP ** dasMCtntivo 
in tkeiMvo-iban. and an incwoaa of 



in 



tiMM thronghont 
theoHlcriiad^idil 



the 



bnt eiporiaBy in 



S. 80 far aa nnqr be d a t am dn ed from the anMll 

of hjrpanlQnoMMni* with advanced 
lova hypartfopby and hyperplaaia of 
the tkyioU, the total naamr of oalla m the cervical 
ajrmpnUMtfc fingtia it not gioaily lodncad, hot a 
vary Intipt nwportion of the ceOi prHcnt ahow vary* 
Im ihm^n tnailtffil dofenenuon. The partial 
of dinical synuMoaMi aoooMpnniad by 
of the porandmnmona kypcttrophy and 
la b the tlqnaid, ia nnodatod with a nmch 
fodacilon in the total oombar of crib In the 
bat of the calb trtuch lanMin idallvily 



of dofmvauoo than 

itt inilM oifty iintaa 

f fn i ill ai n Thaa, in jMMrnl» the pnholoi k' 

I the cwlcnl qraipaihatic giinH* wo 

the ataft and intoMiiy of the qraptoma 



irwrr mk>w iqc varying 
dolJMaain 

chnnna in 
pnraflal to 

of hyparthyroidiani. and to the' hyparalniclc and 
in the thyioid. iWa ainlo> 



MU, hoaover. rou*t lie regaidod aa only taatnlho. 

andwiiit ■■■!! iiiiint liimhji rairfnili u iiiililiil 

^■^tffi god p e! h iy tfttii' fiadiaa of a nrach famv 
nundMr of caaea, the anthora otate. 

Whether the changea obae r ve d aie the reaolt of 
oventinuUation and o va i a otk of the r^g**— * ceila. 
aa Ciila beliavea b trna of the Purfcl^la cdb of the 
oerebnun, or whether the rhangBt aro daa to ^irtf 1 
tonic action upon the oaib fhMMilvii, the nalhon 
beMovo baa yet mere ipacalarioB, 

Gnonoa B. Baoav. 



W. 11. B. : The Etioloiy and lYaataMai «f 
Baopbthalmlc Golier wtthSpeciol Rafereace •• 
theUeeorilndtaai. JTW. /Wii ArCifr. 1916. c«, 
»7». 

Hvperthvroidbm is not the ooly etiological factor 
in Gravea rtiicaie, Nor b euargBaMBt of the 
ihjrroid alwaya aaaodated with fwphthalmoa, and 
both esrmptoaia may be abaent in an othowiae 
tvpical case. Tbe etiology b vet obacufc. bitt two 
ineoiiaa have been advanced: tne glandular, and the 
nenrogsnic Against the glatKlBlaf theory mtliiaies 
the probability of tbe tbsrmua, suprarsnaia, hvpoph- 
jraia, and ovary, and poMiblv otncr internal aecte> 
toryglaoda,bdngetkilogicaliyinvolvod. Thefacu 
at our disposal aoow that a p ro dJ a po s Jn a factor b 
which U to be looked for in tne central 
tjTMem. Thb ctplalns the directlv ia> 
Esophthafanic goiter may follow 
typhoid, rheumatiam, diphtheria, InfhMnia, and be 
pieaent in tuborcnioab and rhlofiab or, 
to hicCarrison, it may be doe to some 
infection. 

Aa to tieatflsant, there b a reaaooable p ros p ect of 
recovery in a b ou t sevettty*ave per cent of the asedi* 
cal aa well aa the surgical cases. Thewordcureb 
used in the sense that the condition b 
aa to no loo|ger interfere with ordinary < 

Passing m brief review the variooa 
"whoao nanw b Moo ' and about wUch the 
contmtBctory statements are cnnont, iha 
daab nsore spedicaUy with 



Roeaigan tioatmant has been i itensively 
both alone and in oombinntion with suifsry. Satlft> 
f aaory reaulta have bean iqnrted by aevoral wiitan 
(Kienboeck, NafrisdunMt). and others go eo far 
aa to say tbu no opsfatioa lor thb condition should 
bo tmdartaken without piwminary tioatmant bv 
I rays and that If thb proeadara worn tm^ 
adopted it eroald be likely to m n lmb By 
the oparativo aioitality of iiinphlhalmir 



the rays have a favorable 



GENERAL SURGERY — SURGERY OF THE HEAD AND NECK 



II 



esoanive, deficient, or p e r tre m foacUoo ot the 



CHalcal opviMoe tliows that nuuqrcMCtdo doc 
itapood Mtklactorily to any ol the mclhoHt men- 
tiooed, and in these refractocv caiea the author haa 
fooad the emplovment ol radiiim to be ol dedded 
benefit. Abbe of New York fif»t used radium rac- 
ceMfoD^ in exophthalmic goiter, and hit favorable 
reiuiti have beien confirmed by other*. The ex- 
periments ol Victor Honley and Finsi show that 
the moat constant changes after the application ol 
radhun affect the blood and lymph-vcssds. The 
author's dinical cxperieooe shows that the more 
penetrating radium ravs diminish the vascularity 
and reduce the tecretloo ol the ^Und. Dawson 
Tomer thinks that radium has two definite advan- 
tacrn over roentgen rays: the poeaibility of giving 
donite doiea, and the possi bil ity of administering 
it without noise or excitement while the patient 
remains in bed. The author reports seven cases, all 
of which were benefited by radium treatment. 

In conduston, the author brieily deals with hydro- 
pathic measures and refers to the psychological 
aspea ol the condition, which he considers ol si^fi- 
cance in relation to the treatment. He, therefore, 
thinks it highly advisable that physicians who have 
not had mudtk experience with neurotic and neuras- 
thenic patients, and consequently do not understand 
them and have no sympathy with them, should 
refrain from undertaking the medical treatment of 
cases ol this kind, in which the psychic element is such 
an important feature. 

Pfahler, G. E., and Zullck, J. D.: The Treatnaent 
of Exophthalmic Goiter ( B asedow's or Grays' 
Dtsease). by Means of tho Roentisn Raya. 

Pemm. i/. J., iQtt, zix, 66i. 

The authors briefly review the theories ol the 
atiologv ol exophthalmic goiter, espedal emphasis 
b^igdirected to the work ol Kendall and Wilson at 
theMayo Clinic. The dose rdlationship between 
exophthialmic goiter and hsrperplasia of the thymus 
gland b shown by numerous quotations from the 
uterature regarding favorable results obtained by 
exposing the thymus to roentgen rays. Similar 
favorable results have been obtained by other ob- 
servers after exposing the ovaries to the ravs. 

The theory ol the beneficial action ol the X-ra^ 
on the thyroid in exophthalmic goiter b that in thu 
disease we have a hyperplasia ol celb and adni, 
and the X-ray b known to have a selective de- 
structive action on highly specialised epithelial 
ceOs, especially those of the embryological t3rpe. 
There b a mass ol evidence in the literattire both for 
and against the use ol tlie ny% in exophthalmic 
goiter and by a purely statistical stiadv it b unpoasible 
to arrive at a definite condusion. The authors have 
given the subject very dose study and from thrir 
own experience in twenty cases have worked out a 
definite plan of treatment with the X-rav which they 
give in detail. Thdr work leads to the following 
condnsioos: 



I. It u justifiable to give all cases of enphthal- 
mic goiter a trial treatment with an interval ol one 
monuitoobisrveiueflea. Nothing b lost tf opera- 
tion b then dfddffd upon, and many cases «i n thns 
be saved from operauonT 

s. Treatment should he directed at both the 
thyroid and the thjrmus glands. An increase in 
wei^ and a decrease in pobo-rate are the first 
signs ol im p rov em ent and are practically always 
found. Hypothyroitttsm will be produced bv too 
prolongs' at. The goiter and the exophthal- 

mos thou any improvement. E. PuoncL. 

Judd, E. S., and Pemberton. J. D.: Reenlta of 
Operatioaa for Es<»phchalmic Goiter. Mtd, 
Pr$u (rCirc, 1916, cii, 135 



The authors present a statistical study ol 
operated upon at the Masro clinic in 1909. 01 the 
176 patients, 121 were traced. These 121 patienu 
are divided into five groups: Group 1. Ftlty-five 
patients, or 45 per cent cured. Group 3. Twenty- 
two patients, or x8.i per cent, practicallv cured of 
their symptoms but still had traces ol the ditfaff- 
Group 3. Seven cases markedly improved bat most 
of the time there was evidence ol the old trouble 
— exophthalmos or nervousness. Group 4. Five 
patients with only slight improvement. Group 5. 
Eight patients with little or no benefit. In Groups 
3, 4, and 5 are several cases which had onlv one or 
two ligations and which mi^t pomibly be cured 
by a resection. 

The average length of time required to effect 
a cure was 17.9 months. The average length ol 
time the "cured" patients had symptoms before 
coining to operation was 19.3 months. In the group 
receiving no benefit, the average time of symptoms 
was aa.2 months. In spite of the doseness of these 
figures, the authors believe that a greater percent afe 
« cures would have been effected if the cases had 
been operated upon earlier. The tyt sjrmntoos 
(all the cases in thb series had distinct esopathal- 
mos) were the first to improve following operation. 
Some patients with the subjective feeling of tension, 
stated that the eyes felt much better belote any re- 
duction in the exophthalmos was noticeable. 

In regard to the functional results ol the opera- 
tion, the low collar indsion heab quickly and normal 
function ol the head and neck retunu in a few weeka. 
Disturbance ol the voice was noted in some patients. 
It was apt to become marked the loorth or fifth 
day, but always disappeared. 

Of the 176 patious operated upon in 1909, 
ai died, 7 in the hospital. These patienls wen 
all operated upon at the maximum of the leveritjr 
ol the disease, because at that tioae the danfer of 
operation at the height ol a paroxysm was not •» 
fully realised as it b at present. Foorteen paUentt 
have died rince leaving the hospital TbeyHvedan 
average ol 14.1 months. Eleven had dilated hearta. 
there was cedema in six and evidence ol nephritb in 
lour. These cases were ol the extreoM type with ir^ 
reparable damafe to vital orfUM. B. 



II 



INTKRNATIONAL ABSTRACT nr ^fRGERY 



SURGKRY OF THE CHEST 



CBBtT WALL AND BtlAST 






TW amhar 
irnol 



(BsttailMnlt TlHn 

iiifwwl t l Mw aca p lM ty la it 
nhmtwktk tfawt Ua», 1914- 



o( Um tin Imib tlw dtvcoih or 



umk to Um tlM or Mcoad ladwhrt (omi the &nt 
lib wm ImMi4). Up to its loaaio cnuioMim 
kov* bt« iMKliit, but tbt MttMT bcHevci that 
•odi ft liiat ftMft b Ml Mcanary, ise to ije ccati- 
■Mtcn btfait wiWriiiii is bmm casHw row po* 
licBift wtn oMod "~ > cfttBt wsfv opMfttod OB mors 
Ums a jrcon afo, om o yoor md, aid om tkreo 
il» i^o; t dfed ft eamMm&m tkm ftftrr the 
— Qftsd 5 bmmmIm— InNBattftMioaofthe 



tybtnolw proc^M is tlw hmg oad from hamopiy* 
rf»; oat b Imag two yoan after iht optnitfcin bat b 



b Hviac a yoar af tcr t he 
b better tbaa ionacrfy bat ilvw of the 



dfed ooe to too «oda after the operatka, 
> of iaf ffctioa, ooe of aa OMmovB caowt probably 
heart faOorr. The aathorbdevm that the lafectioo 
ift ihr two fatal caaca origiaated in the apei of the 
loag in fpiie of the fact that during the operation no 
fori or ravitka were opaaad. 

In all 1 1 caeca aa atfaarivo krioa of ooe long 
cabled which had beca tiooMd capedaalljr for one 
aad oar heW to two ycaa wbhoal laccaw. The 
other loag ia 3 caeca showed ao *^tfttfi>! symptoms of 
la the other cases odaor '■^■■^gf 
in the other lung but were coo* 



suted that he had p e i lo iu m d the 
thadfacaae< 



op ctali oaia s casca. lajoCtham 
coaiasd taaathmg. la oae case aflar aa apkol- 
ysb ope rat foa iha (Hseaat tpmul to the lowest 
I of that loag; aflar a thoncoolaitlc openiloa 
the patkat bsramr boa Iram fever; the 
caaibctased. aad the bacM dbappoaiod from the 
spaloaL The opetalloa b p s rf o tai e d with the 
podeai la the siltlag positioa to prevent an 



I that 



im be tiiod: If aot sacosstfaTlka operatioa 
amy beadvbed,daeslt baot at al aorioas if the 
panaai b hi foail coadhloa. He has seat from hb 



saaitariam 6 patisms to haw tb? operstloa perfonB> 
od aad la 4 af theae the eiect of tae operatloa was 



KsT had opsmtad apoa j caam of which oae b 
' Bproved. He always lachMbs the ffait ifl> 
aad prefers to operate ia two stagss. The pala b 
aot sevcnt if the operatloa b doae u— irvstiwiy; 
the lolercoslal nerves ihouid be saved if possible. 



Eiraa* had p rcvio o i l y riportod j casai oprraicd 
I aad he abo advised oooisrvatbm aad that the 



oaeialloa be doae ia two stagss. In ooe case all 
liba wars mectad aad the iuugh did aot csaaej 
rcsectloa of the davlda was triad to obiaio a cel- 
Upce of the cavity, bat ooly after a large phig of 
(at was applied <M the spatum decrease to is ocm., 
after which the patlaat was agsia able to rssaow hb 
occupaiioa. 1^ A. J 



llertaler. A. K.t iMemHmU ttt ih* Madi 
Am J. y. .SV.. i«i6. <Ut. 165. 

There arr hut 72 rases of 
reported in the literature. The aolhor's 
that of a womaa agsd twenty-three ytmn who had 
always enjoyed good health. In November, 1914. 
»hr had soow difficulty in rsspiiatioo aad a scase of 
(ullocm ia the aecfc. Sbortly afterward a balgbm 
was aotl ce d above the breast boaa> A number 01 
n ir g ffin if made a (ttagaosb of omdlastlBal sarooom 
andrrftMcd twatmaat. Ftanrination of the balg- 
tog in the soprastamal notch showed a tunwr 
covered with skin and sUghtlyreddaaed. The tum- 
or was tcmirr to the touch aad prescated a semi- 
fluctuating resistance. On p erc tw sio n there was 
dullness extending oa either ode of the sternal bor- 
ders and downwani as far as the angle. A diagaoab 
of mediastinsl dennoid was made. The operailoa 
coosisted in a traasvena lacisioo over the upper 
border of the stermun, eititadlag wcD beyood the 
iasenloB of the tlT iiiriTiiftirH awade, insertioos of 
which ufcre severed, ^aa siip a il oi poicof theyiba* 
lar mam was readily iipoind, Thb was naohr 
i nosed and a grayblHjrcllow greasy fhad eacapad. 
After thb was spoand oat a mam tae liae of a wal- 
nut primal id. Tmi was covered with fuw 
like hab the color of a 1 . 
The appearance of thb mam estabHshad the 



la reviewing the literature the author nolm the 
fact that the asaJoritv of the caam have been ob- 
served ia early adult life, the liigwi number being 
noted between the agm of tweatv aad thirty. The 
sex of the naficwts b aboat ovci^ir divided. 

The pr em oai t o i y Qramtoam are of two groups: 
those doe to pws a uw aad thooe due to inltatloa of 
the fa^roaaiaat by the 
The amat fkoqoMt Byamtoom were daa to ( 



apoa the aavinaBHat by the apaadfam t« 
The pjB ss oi a^ymploamareawot frBq pe at Pra 

1 by coogh nd dy^waat lam oftaa aa pda from 
praaaaii. TMa ymptom was pwacat la aS casm. 
Coogh whea due to pressare b caosed by inbatioa 
of tbs aervas. Cough of aaother type was caaaad 
by bfllatloa of the broachi whea pcrforatloa WM 
impnadli^ Whea dae to Initatloa the chaiactar 
of the om^ b sfaaOar to that noted to pressare from 
aneurism. 



GENERAL SURGERY — SURGERY OF THE CHEST 



IS 



> 



DpfMKra WM noted in aj cmcs. u 
dentil occurred in dyspnoek nttadu. Dyiphagin 
was ptcient in j cnaet. The gradonlly incrcaatng 
nnKNUtt of the cyst contenu pcobnhly underfoet 
tome chrmioil dunge which inflnnet the sac and 
irritates the enwIiiiniiifiiL In this they imitate 
the life histonr of weoa. 

The typical kxatioo of the limple dermoid of the 
mcfUastinum ia that of a sac occupying the space 
tirt wrt n the sternum, pent vcHeb. pericardium, and 
! !^9ucs covering the cpiitcmal notdi. 

In structure, the two tvpca may be diatinguiahed, 
those in which epidermoidal tiiaae alooe b present 
(aS cases), and those in whidi tiatiics from two or 
more germ layers arc in evidenc e (ts cases). 

The simple epidermoidal type osoaUy coosisu of 
a simple cyst or. at most, a conglomeratioQ of cvsts 
the lining of which b covered with stratified epithd- 
tum. with hair follicles, and with sweat and sdMCcous 
gUaids; but a few cysts have been noted in which all 
appendages have been absent. Sone of the simpler 
cysts have compartments lined with columnar 
epithelium, with or without dlia. The contents 
of cysu b usually composed of cclb, fatty material, 
and hair. The material when in a fresh state may 
be honey-like. 

In the more complicated teratoid type, in addition 
to the epid nmo i d a l elements, cartilage and bone are 
frequent!^ foond. Leas often teeth have been noted. 
Glands, supposedly from the gut tract and from the 
tlnrroi^ have been recorded. Non-striated muscle- 
ccOs have abo been observed. 

The origin of dermoid and teratoid tumors of the 
mediastinum b closely aaaociatc<l with the devdop- 
nwBt of the thymus uid thyroid gbmls. The dose 
rdation between the ectodermal and entodermal 
elements in the neck has been pointed out by Minot. 
That mediastinal dermoids have their origin in the 
upper part of the sternum b evident from thdr 
topography. Even those tumors which exhibit 
their greater bulk in the lower thorax retain attach- 
ments high under the sternum. In some of the 
reported rases, bands have extended up as far as 
the th>Totd. suggesting an even higher origin. 

The differential diagnosb must be made from 
aneurism, tubermlosis, empyema, malignant and 
benign tumors. C. G. Hevd. 

TRACHEA AlfD LUIfGS 

Vmsoa. L. P.. d« In: Bxtmctioo of Intmpulnaoanry 
Pralwtilaa with Porcops Uadsr tfao Sown 

(L'cttractioas des projectiles intraMbMaabas 4 
b place s o u s < c ra o). BmU. H m4m. 5w. d* tkk. d» 
Pmr., 1916, xlli, 1889. 

De la Villeon gives a detailed report of hb method 
and the prinrifMl resohs of it. Fifty-eight cases 
have been operated with 58 staccesscs; ji of these 
were penooal operations of the anthor in which he 
removed ^j projectiles situated from i \o 12 cm. 
deep in the pulmonary parenchyma. The other 37 
cases were operated upon by has coUeafocs and in- 



duded the removal of 54 projectiles at vafioM 
depths. 

There are two radiologic iatcnreatioos: (i)forthe 
«act localisation of the pn>|ectlle; (a) during the 
operations to guide the movoBcats of the forceps 
toward the proiectib. The pr oce dur e , as pointed 
out by Faure. b undoubtedly to ft neat eitent a 
blind operation and as such b more or less objection- 
able according to the strict rules of smfeiy; but its 
sococss depends on the degree of skill ohtained bv 
the operator ia the tedudque of the method, wUcfa 
skill can be acmdred by ei p erbnce and practice. 

The method b, moreover, only snp Hc a h l e to the 
smaller and smooth dass of projectiles. Lamr 
projectiles or those situated in the hilum cannot be 
removed by forceps; removal in such cases b 
effected by thorac o tomy. Even if in the coarse of 
an extraction by the author's method an acddent 
should occur a thoracotomy can always be immrdi- 
atdy performed. W. A. BaxmtAx. 

Gtroux. L.: Trauaaatlc Ptttanooary Tubcrculoato 

(Tubcrculose pulmooaire traunutiquri. Prtsu 
mid., 1916, p. 394- 

The author reports two cases of traumatic pul- 
monary tuberculosb in wounded soldiers. In the 
6rst case the patient recdved a baOet injury in the 
right thoradc region. Framinfid four moothslatcr 
by the author the nutn showed bilateral tuhcfcdosb 
of the two apices which was confirmed by radioaoopy. 
The patient bdore injury was a vigorous, healthy 
subject without personal or hercditar>' an tecedent s. 

T\^ secotid case was similar but even more de- 
monstrable. Thb was a healthy man, who for 
many months had borne the hard life of the trenches 
without suffering. He recd v ed a vdaminoas shdl 
injury in the left breast, causinc aboadant nitting 
of blood and functional dbtnrbance. Within 
ei^t months all the symptoms of a loraHird tuber- 
culosb at the traunutixcd point were noted. 

W. K. Basmujc. 

Uunbert, S. E.: Suppuratkms of the Lung and 
Plsum with Thair Surgical Indkatkicia. Stuk- 
weU Mtd., I9t6. xv, S5J. 

Since nearty all suppurations of the chest are 
secondary, the author bdievcs that careful taldag 
of the history b of the utmost loBnoirtaace. For- 
dgn bodies, tranma, tumors, sypldlb, iafiarara, 
pneomoaia, ptitumh, operative prooedwcs of the 
nose, mouth, and throat, laparotoaqr, ahaosss of 
the Kver.perir en d abacess , a olau a ^ rcos b aad always 
tuberealoab. arast be t oas i dere d . Uarsiolved 

I lanbla tw fa ihnr in arrrfri at t TttV— *--r *" 

evea a woridi« diapoab. Tlmroagh phydcal 
esaiaiaatioa aad a carmd eaariaatioa of the spa- 
tarn should be made. Hcmoptyda b of Uttle diag- 
iifffflf ioiportABce. 

Lambert believes that the roeai«ea ray ena- 
inatioa b very hdpfoi aad ahoahl be asad wtoh 
both screen and plate. In tfiffcreat posilioaa, wU 



14 



IKTERNATIONAL ABSTRACT OF SURGERY 



iH^gcfini Of M !«• vahM !• tioo*. LAmbcndo«Mlbili«ir«latlM««ol vacdot 




lobtMlt 
dbilaci tdvM- 



btwta if 
or local 
IW «p« Mdwd. In 
bMkt 
lapo for po ompn ummkmi^ 

TW iioifclBi Of tiM poikM 00 ibt toUo b omm 
iMMioai: pnfHohljr, Im ilMoki bt Ijrlac oo iIm 
•booawooroo Uwdbtoiidildi^ Mvor oo ikttooad 
Mo. TW vwuol poAloo it iW lotei. lo iht 
of coltpw m NMili of paoomoihiiiM whttt 
llM huif tlNold bo fTMpod or Um loaf 
id to ibe tanwndtaf wall aai|ia. 
Otmlaalo. paifid broMbhlB mm btoa MMMHfaQjr 
inaiod bjr attHdal wwaawtboriw. ■• baa alto para- 
Ijrtk idaatioa of tbo dtephncBi bjr <ttvisioa of Um 
pbraaic aarvt. BroacMaciaiBt Laflsbact baUawat 
Cdlbar oporable or jacatablr Tba mortality b 
bigb. aboat «o par caat. Tbe beat raaalta are 
paabably obtalaoQ fkoai pialiariaary aitiAcial paco* 
awtborax. or bjr Ipalte of tlw braacb of tba pul- 

' ' iovol wd 



tbraa f acton: (i) 

of cavity by rrodar- 

of hiap aad cbaac wall; 



oparatloa aia: (i) huM oipaadJaa 
Foarlar. Delonaa, aaiTRaaioboa; 



•rtaty, 



of tbe 



auy be treatad by lioiple 
tba foOoiHiV cosdbiooi: (i) if 



Bot fraakly paralaat; (*) if paaaoMWOocal oraan- 
kam caaaot be groara oa aalture media; m if 
dat to tabcrcaloM, aot tacoadarily infected; (4) if 



"ff, 



aol dae to ttiaptoooocL Eo^iyHaa ia oftaa bboto 
aaccaarfal aritb cbOdm tbaa «itb adaha. If or* 
phgr^ awibnd of fonaala aad gKyoeriae inj«rtiooa 
Mt aol oMt witb fMMral accaptaaco. He bdicvca, 
of tboaa opvatad apoSf 50 per ccat BMka a aoMotb 
Tt >SPc ccat laqaifa two or aMM« oparatioaa, 
QT of tbata aevar looovar ooaiplaialyi wbile 
<Da dariBg tba fbal few opoaka* 

tbe {n Httfta wbara tba atpifatiag 
Btraied paa. Hbwcvert iatarcoa 
tal diaiaajii or A etdeioa ia batter; prrfMihr tba 
aiaib or taaib rib, betwoeo tba poatarior aiulary 
laa aad tba tip of tbe tm n nH. tfcftaM bo aadaed. 
LBaatbal*a aMibodj uuabcrt bal i avaa, ia 
wortby of rnarfdaralioa, akhoagb it baa beea too 
Ittle oMd to JaaUr ha acwplaaoi aa a autffced ad- 
Toace ia tbe tnataMat of tline caeea. Ha beiiavca 
ia tbe ow of a balf-lacb rabber tube for draiaage. 

ba aaAdent to 

■■aia uniil 

obBtorated tbe cavity. 

ratbar too loag doca ao 



blowi^ 




la tba aM of aactioa to aid tba 

lagi. tbarabbar vahro of Cabot ia 

tba after tM9, tba diaaiii^ ibould ba cboM 

qpilly. tba beat of lyaiialc lannaarlap f 

aad puaaoaafT daaoMa aaad« aacb aa 



bottloi or a bora. 
Ia tbe dnoaic 
to dnda tbe 
aflar lis w«eka» to 



aa a prtHadaaiy, it ia wiea 
poiat of tbe cavity, aad, 
w of tbe radical « 



dUMatty of diagaoaiag tiaaaiiy pa 
favorabw tiaM for oparaiiat to pa». 
of oparatiiig b ilBipla, bot tbe locatic 



_ (») 
BoaAla tba f tt ata n 

Tm lypea of oparatloa aia: (1) 
dacorticalloa of Fowlar. Delonae, «.« , 

(a) parietal coOaprfM of OaailaBdar, ScbadOi aad 
wilna; (5) aMtadalBbf aa advooatad by Robiaaoa; 
aad U) estraplaaral fat laiplaaiatioa of IViOer. 
KociMr*t praoadofo aaaoM tba BMat logical; tbe 
valaaofBock'kbiaflNttbpaato.ialbaaatbor^opialoa, 
bHadtod. Acatoabacnaof tbabngibpafftiadaily 
aaianahla to aaifary; dnoaic ebarw b alwaya alow 
oa affTHiat of tba aiaaof ladaratc paoaaMaia w bicb 
tba cavity after a Mwwodtt. The 
of diagaoaiag oaaaOy panalta tba BMMt 

Tbetedudgaa 

cavftlaa ai^ ba aidat dlttcalt 

In ooadosioa, LaadMrt ininhiiina tbe folloariag 
points: 

t. X-ray and broacboeoopy are BMMt daairable 
aids in cbeit auffery. 

a. Do aot operate with the patient lying oa tbe 
Mwod dde. 

J. Do not aapiratc lung abaccaea tbroagb tbe un- 
opened cbeM wall. 

A. Enept for emergency . drainage, nuke tbe 
iaosioa aoikkatly Urge to eaplora with tba baad. 

5. Wbaa ttsiag the rib epreadar, guard agaiaat 
lacaratlM tbe diapbragBL 

6. Tractioa 00 tbe loag leneaa eoOapae from iad« 
deaty prodaoed poeumotborax. 

7. DO aot attempt too mocb at a time. Shock 
b at ita worst atxNit two boors after tbe opara- 

8. Be prepared to change tbe diagnnah after tbe 

CDCSt is OPQttOQ* 

Q. Do not irrigate or inject cavitiea that coaaoct 
with the broadras, or remove draioage too oaifar. 

10. Reaoororfalaaaa aad iasa^aatioa are valaable 
assets in tboradc tfagaoab aad oparatioo. 



I. C. and Gorrahaa. I. P.: Saraoanoffi 
Luag In the Infant (Sarcoou de pdaMO ea el 
dao). Ffmut mi4d., Arfoit., 1916, HC 7S> 

Piiauuy aaicoBsa of tbe 
cstreaMiy rata. Acoordlag 
aad other aatborSi tbcra aia lam tbaa ai 
ia tba Utaratara. Tba aatbors state that thars are 
aoBM Aifeatlaa caaaa which do aot figare ia the 



luag in rhildbood b 
toZabor, «*!»■»•>««« 



of tbe laag are more fr»- 
Ifasllar la iSot ia a total of 
taasors foaad ta.» par caat 
w. «—.,— _jaa la cardaoauua aad J0.0 

par'csat ia iaicoBMta,wydi shows that pabaoaaiy 

Bora ffoqasaily with sarnnma, 

of al olbar regions are macb 



GENERAL SURGERY — SURGERY OF THE CHEST 



«5 



mote t fcq u coiiy otMcrvcd in firinoma than in 



Tbe autbon rnoft the deuQt and histologic 
findingi ol a case in a child of 13 yeart, in whkh 
ahhoogh the tymptoaatoloor approximated more 
to the primary type d puunonary sarcoma yet 
antopsy showed it to be a case ol pulmooary meta- 
static saroooia primitive in the tibia. 

W. A. BaxMMAM. 



F.: PriOMffy Loi^ Sature at the Proot 
(Die prifflaere Luatmaht im Feldc). Beitr. s. 
iUm.CUf., 1916, cut. 

The author iHsmssei the immediate operative 
treatment in the field hospital of chest or lung 
woonds which are complicated with open pneumo- 
thorax. He operated upon 9 such cases: 2 with 
open pneumothorax without clinical evidences of 
lung injury (both died); 5 cases of open pneumo- 
thonx with lung tearing (a deaths); a cases of 
open pneumothorax with injury of the abdominal 
vttcene (1 death). The clinical details of these 
peases are given. 

From the observatioo of these cases Landois 
draws these coodnaioiis: 

In the case of gunshot lung injuries with open 
pneumothorax at the front, dostire of the injury 
by suture b to be effected immediately. 

i. Qosure of an open pneumothorax is best 
effected under hi^i-pressure narcosis, suturing the 
projecting lung with circular sutures into the 
thoradc cavity. The Auer-Mcltxer high pressure 
apparatus as modified by Burckhardt is used. 
This procedure prevents collapse of the lung should 
infection of the pletiral cavity set in causing a total 
empvema. At the same time any existing rents in 
the long should be sutured with fine silk. 

J. In the event of combined injuries of the chest 
and pleural cavity, the best method is transdia- 
phragmatic laparotomy. In cases where the liver has 
been injured this is the established method. 

4. In most cases of open poetmiothorax in war, 
a secondary empyema occurs. Thb b treated by 
typical rib rmec t ion. W. A. BBKinfA.s. 

HEART AND VASCULAR SYSTEM 

f^omanlrl.L.; Separate aodSlmaltaneousU^tiwe 
of Che Gocooary Artcrica and Vdna of the liOHt 

(Lcgatora separata e umultaoea deUe artcrk e 
oeOa VMS ooeonarie del cuore). Ptlidim., Roma, 
1916, xxffi, MS. ikk., 155. 

Domenid's experimental researches were made on 
dogs. Anatomically he finds that there b a similar- 
ity in the diipoairion of the coronary vcaseb in dogs 
and man. The firtt parts of the two coronary 
aitcrica are not accompanied by veins: the ventral 
artery b eastlv reached, but not so witB the doiaaL 
If it is desired to make a compensatory vcnoos liga- 
ture after Ugating a coronary artery in its first part, 
it b necessary to Ugate the great coronary veins in 
the left aitriculoventricular sulcus. The auriculo* 



vantikular branch 00 the left aide b isolated at iu 
fiitt part, and it can be easihr UvUed there so that a 
oompensatorv ligature of the grsat coronary vein 
most be made at thb point. 

In Domenid's series of more than so experiments 
he has Ugated the coronary vcsseb in dog^ either 
isolating the prindpal trunks and the collateral 
branches of the two coronary artcriea and the great 
coronary vein, or contemporaneously Ugating the 
arteries with the corresponding veina. fnok these 
experiments his deductions are: 

I. Ligature of the superficial ventiicolar, collat- 
eral branches of the left coronary b innocoooa, cana> 
ing at most, and only in some cases, fod of fatty 
induration. 

3. ligature of the left dmimflex is more danger- 
ous as it causes alterations <^ the myocardium more 
frequently. 

3. Ligature of the descending intraventricular 
part of the left coronary b still more dangerous 
because it almost always produces ^"««»f*tiflTf ar- 
rest of the heart action. 

4. Ligature of the left coronary at its origin al- 
ways causes stoppage of the heart. 

5. Ligature of the ri|^ coronary produces leas 
grave and more variable results because in dogs thb 
b always less developed than the left coronary. 

6. Ligature of the great coronary vein b innoc- 
uous. 

7. By contemporaneous ligature of the vein to 
the arterial vessel (compensatory ligature) the grav- 
ity of the effects produced by the ligation of the 
artery alone is decreased. 

The author thinks that these results dmend upon 
the anastomosis between the branches of the con^ 
naries, which although diversely developed yet al- 
ways exist both between the coronaries and the 
sojo 9asontm of the aorta and of the polmonarv 
artery and pericardial vessels, the existence of wUch 
b confirmed by the survival for three hours after 
the ligature of both the coronaries. 

The author further believes that immediate stop- 
page of the heart after ocdusion of the artery alone 
at its origin or along its intraventricular part b doe 
to the disturbances which are produced in the na- 
trition of the mnscolar fibers and of the intxiaric 
ganglionic system, aa well as to the merhaninil ob- 
stacle which the strong stasb produced by the Hfik 
ture must o0er to the myocardial function. Com- 
pensating ligature by dinunishiflg such venoot ataiia, 
according to the ideas of the aathor, nuikca ■■ tril lon 
and the myocardial function pomihle natfl • coflat- 
eral drculaiion b estabUshed and that leaeni the 
gravity of arterial ligature. 

The author has collected from the literature iS 
cases of various woonds of the coronary vcsseb of 
the hem in man. From an etamination of then, 
ftiy^ from anatomical considerationay he 
that the resnhs ohtained from the 
dogs and the conridentiona rdallve to 
witn great profit be citcaded to man. 

W. A. Bbssouul 



|6 



INTKRNATIONAL ABSTRACT OF SIRC.KRY 




WoMtf «f PMlMtar WUI 

IS> MtaOf fipQItt A CMC HI WHCll A PMW 41 

iMd lodM ta tlM poiurior w»B of UM Dirt- 

Mln afl« Um faijwy. tlM foratfi b«|]r Ittviat 
Um Umm at IM poMMlor uliHy Bat. 

Al iMi Itet tlW P*UmI MMltd (km llMHtDMi of 
btMtll OB OHItlOII, ffOpid pllH, Ud ft tlnpiftiHd 
ptiiilBtlMCkHL 

Tit X-«igr tktomtd ft fenigi Mjr dUMtcd ipfNir- 

hfi of IM ■■■■■ BMb poiionoily. 

TW pakftfdhM «■• Mpooad tlupoQgli ftft ftMorior 
iacWoft vllkoal IMwy to Um pltira, aad mm 
oMMa llwosi^Mll Its Pit ml fitMD ftoow oownvud. 
TW vkjita mm kmtd oftd about iwo-thifdi of the 
' to ■• vitbotti the pericardium; it «%• 
Us lirtl and rrmcnTd without 



TW DftllsBt «adt •■ oscYcntfttl reoovcrv; by lbs 
umkmy tbo polst bad iailoa toaigb^ beau par 
niflridr. aad be was perfectly oooifoitable. 

D. L. DcarAas. 



PHARTIfZ AND dSOPHAOUS 



oU 



t«t«. Jaljr. 

■ad of a gradually 
Ha could not lie 
Dans soaao wiu aavara cxrapDng 
iia, aad ba East waUtt. HcOar's ftufHiim ana 
pufartd , ■ nt di lfa i of tbe left conratDia, 
sniitiag of tba parilOMDDi over tbe lowest portka 
of tbe aaopbagasL Tbe oraopbagus was tben llbcr* 
atcd «iib tbe iaper tbrougb tba blatos for a dis> 
laaca of $ cbl; tie arascalatvc was divided down 
to tbe latiBiDfoss ooe on. above tbe caidla, and the 



Tba paiiaat b weH. aad 

I gftlDad so poDDOi la ibiaa aMatlsk 

lUwiiw stftiad tbat ba bad p a rt ^ a wd a aiscrot* 

oaijr ia a casa of dBatatioa of tba caidb with mrc. 

Sboitly aftar tbaopantioa It waa sbDWB on 1 he X ray 

piftta tbfti «mI aoband to ihr walb of the oesopba- 

eTysdhftppiildliHrabowtnathataninitnM 
faaprowMat bad takaa placa. Aaotbar pa* 
liaat was Hw f fly * witb a parforatad «*■»«»'*— tt f uJSr 
wMcb was tataiad. A nMotb Utar a gastio-aatar- 
ostoaqr bad to ba p e rfo raMd for pala and vomlUac. 
Later voadtlac *fl>^ dawje p sd but of a aaw oriflii 
witbqratptOBMofcaidlaipasBL It b probabia tbat 
tbb was due to tbe fact tbat tbe patieat aaoatly 
SBMkcd wbOe in tbe hospital aad swaOowad tba 
InuMovanaat foBowad bougie tiaataMat. 



BACXSft'OaonniABL repoitad tbe case of a js- 
ysar^dd woman, who siaoa bar siataeatb yaar had 
sufctad from an incvsasiag grade of voaduat. At 
so sba bad qrmptOBM of gsstrtc aloer, at 14 mttna- 
Tba namiaafioB ibowad ptosb and sevara 
in the Urge ventiida as wail as cantt^ 
Gastro^nterostomv aad gaattopesy wata 

lowadi later, bowavar, sba araa tiOHDiad witb violcat 
vomitiag for five yaan with a loss of sj kg. ia body 
waUbt. After irrigation of the cesopbagas aad 
moNHiatinn of the left curvature a plastic Flaaey 
oparatioa was performed on -the canUa. Tba pa- 
ticnt was St nnt (cd throu^ a Jejastaaoloasy 
opening. The X-ray now shows a good 



performed Roepke's oparatioa 
in oae caae after mobiUntloo of tbe left curvataia. 
It was iBqMMsible to looasa the oesophagus from tba 
pericardium. It waa opeaad aad taca sataiad. 
Tba operatioa was oom|Mtad.bat wbHa tba CftvAa 
was boag tcatad for pataacy with a sound a psrfofa* 
tioa of taJB flrsopbsgns occurred. The ventrida waa 
uitured to the diaphragm. Death occurred oa tba 
^th day from infcctkm. L. A. J 



SURGERY OF THE ABDOMEN 



ABOOMUf AL WALL AMD PEEITOllBUlf 



S2 

walla 



the geaeral liaea laid dowa by Sir Ji 

in his **Syaq>loiM aad Tlwir latsnaatatloat'* witb 

the rssah tbat bb obaarvatioa stiiUagly co a irm a d 

the Utter. 

afcbaAbtfaariaalWaRte lie fust triad vaiiona aMtbods of cHcitlaf icfks 

of tba AbdaaibMM Visesn. iVsa* respoaass. bat iaally adapted tbat of grasaaM tba 

dn^rntr. Land. 1916. tcrti. 106. aU^ ftftd wi ^ fM t a iw t ii'^sasa inaly bctwaea tba 

Uvst records bis abasrvaiioai aa tba dhMostIc iagar aad thumb aad drawiaf thrm sway fram tba 

afaaulaHlpalaiaafbypMHtbmiaaftiaskia daapsr layers of tba abdoarfaal wall. If aa bvpar- 

of tba abdoadaal viMan. caa taO by tba facial aapramlaa, wbaa oacb aa 

BafsrfitbataltbapafaitbataBatiaataaaipWaa area b beiag stimulated. 

, aad tba tiadsrasm tbat aa ebaMrvsr caa aHck Tba aaMunt of pain varias» asaaBy whea tbaas b 

to be dae to a traa vbcsraaMiaqr •»- ihaadaai evideace of acata iaiaauaatioa, tba pala 

fba, aad aat fai aay wsty to paia or taadMMi Mt p tadacsd by puMag b acata. Ia a coarfdoraUa 

faitbeo^paitasif. Ia Ha iavast%stioa ba itftowad aaaibcr of caass tba patloat bai hardly adadttad 



of. 



GENERAL SURGERY — SURGERY OF THE ABIX)M£N 



«7 



that the piadi hm camtd actual paia. tbe mtatioo 
p god ii c a a bdag cvidcatlx dUBcult to define, but 
dcicribcd aa **€xaiam," "onpleaaaDt," "different 
from other placca," etc. 

Ugat'» oucnratiooa lead Urn to locate the hy- 
|M I iliaiif areas as foUowt: 

I. That (or the gall-bladder b situated where a 
boriaontal line drawn from the tip of the tenth rib 
croMci a vertical line drawn midway between the 
nipple line and the middle line ct the abdomen. 

a. The maiimnm appendix point b situated at the 
junction ct the upper and middle thirds of a line 
dnwB from the umbiHctts to the right anterior 
Mipwi o c ^line. The fallopian tube point of hy- 
penrlhwia b at the junction of the lowest and 
adjacent foatths of a line drawn from the middle of 
Poupart's ligament to the umbilicus. In gastric 
or duodenal uker he locates the maximum point 
exactly midway between the ensiform process and 
the umbilicus. 

J. That of the small intestine, excluding the first 
part of the duodenum, U situated in the midline of 
the abdomen, not higher than a point at the junction 
of the lower an<l midiilc thirds of a line drawn from 
the enttform to the umbilicus, or lower than a point 
at the junction of the upper and middle third of a 
line drawn from the umbilicus to the symphysb. 

In regard to the large gut the maximum point is 
located centrally in the lower half of a line from the 
umbilicus to the symph>'sb. D. L. DxarAxo. 

Ceballos. A., and Segiura. C: Acute Tuberculous 
Pcrltoaiiis, Pcrftonoal Granulla (Pchtonitu 
toberculoaas agudas, Granulia* peritoneaks). Ret. 
Astte, wULt Argmt., 1916, xxv, 50. 

The case reported by the authors was that of a 
young giri. 16 yean old, who after a severe attack 
of Cfi^astric pain followed by bilious vomiting was 
lu apr e d to the bonital in a grave condition. 

The wrmptwa iwficated peritonitis. A para- 
umbflical tapuotomy was done, the stomach and 
dttodcDom being e^ored, but nothing of impor- 
taaoe waa found. The small intestine showed red 
coto ra t i oo and there was some dear acnma fluid in 
the pcrilooeal cavity. On the loops and wwentery 
there was a large dinlay of whitish grannica, cs- 
pedally abundant in the oecum and in the appendix 
which was free. The parietal and visceral paita of 
the peritooema showvd the same conditions, the 
granulatioaa <ttqilaying preference for the vidnity 
of the mcmitefk vessili. There were no adheicncca. 

An appendicectoonr waa done and the abdomen 
closed without drainage. Reoovcnr malted in 
twelve days. The result of iaocaklMW aade with 
preparations from the meao-^ipcadbt proved that 
there was a tubercular badOavy procwi. 

The authors are of the opimon that the perito* 
nitb was due to the lesions found and that aaMlioi»* 
tion was afforded by the opening of the shdoaMa. 
Peritoneal graaalia has always been consi d er ed aa 
an incJdeat of dumiic geaeranaed graaalia aad out- 
side the reach of saigical intervtatkm. Medical 



Htcntaia offen sone catca which wnaihh thb 
somewhat, but the authors have aoc been able to 
iad a case exactly analogous in S3rmptomatology 
to thb. W. A. Basmuii. 



A.: Modem Trcatmaot of Acute P«rl- 
tonltls. InUrmat. J. Smrg , 1916, xxix. J43 

The modem treatment of acate peritonitb b based 
on certain definite aad practical criteria. The 
greatest absorbiag power of the peritoneum b 
poiseMcd by the teadiaont ceatcr of the diaphrag- 
matic portion, and the least by the mcscaterica aad 
broad ligaments. The naechuism of the carreata 
which carry partidca from every direction toward 
the diaphragm diieflv depends upoo mo v em en ts 
of that organ, insolu b le sabstaaoea paaiaf iato the 
Ijrmphatic tissues of the teadiaoas <naphragni, whOe 
soluble snbstaacea follow the blood stream and are 
absorbed more rapidly aad from all peritoneal sur- 
faces. Absorption b hindered by abnadaaoe of 
fluid in the orpuiism, by veaoas h )r prrrmi a, aad 
by cold; it b fadlitated by loss of water or blood, bv 
arterial hypenemia, by heat, aad by high blood- 
pressure, abdominal massage, cxerdse, etc. Bac- 
teria, like other insoluble bodies, follow the lym- 
phatic route of absorption. 

Diffusion of peritoneal sepsb b opposed by me- 
chanical and biological factors. Masses of fibrin, 
leucocytes, endothelial cells, detritas, lymphatic 
thrombi, etc., block the peritoneal fisnrcs aad coa- 
stitute a first line of defense, bevood which there b 
another line represented by qraqih-^aada. Ex- 
amination of peritoneal exudate has shown an in- 
creased number of macro- and microphafes, in- 
creased bactericidal and antitoxic action, aad 
proteolytic properties 

These findings saggest the following steps: 
timely intervention, raoid reaioval of the caase, 
drainage in the most dependent part of the ab- 
domen, no manipulation and no lavage. Fowler's 
position, and proctoclysis. 

Eariy laparotomy b of the greatest importance in 
facilitating precision of techaiqae, while iacisioa 
over the point of the causative Icsioa obviates mm- 
nipulation. In peritonitis originating in the viscera 
of the lower half of the abdominal cavity. Mc- 
Bumey's incision b suggested; in that produced hv 
ledoos in the upper nut the iadsioa of sls cti oa m 
across the right rectas, thas permittiag rramiMtin a 
of the stomach, pylorus, duodcaam, aad gall- 
bladder. 

^Iliile many believe that dralaafe b i^jatioaa, 
if done carefully it may accomplish iu parp oeewjth - 
out injur>', facilitating the nmonl of pvraloat 
exudate collected in the BMSt denradfat paita aear 
the poiat of origia of the p erit en ftb 

Maay aathora coasider the actioa of d nrfaa g ff la- 
dbcthre, aad therefore they dam the p eri toas am 
cooolctcly. Graatinc that tsmpoaafr aad drafai- 
asehave only a traasitory b earf i fi al «ect, vet dar- 
Im thb tiaw a large pan of the flaid which woald 
otherwise remain in the abdoawa caa be voided, aad 



la 



DfTBRNATIOSAL ABSTRACT OF SCRGKRV 



iW 



llMt 



tkmAi alvvfibt 



•f« oliM tdMUkal wltJi Umm of 



la IdbMMlonf cwiJfcloM of locoM doit 
tW cswloio b pitodpiRjr colociod te tko vidalijr 



•hramciB for 
tlw iinalNHiy of 




J.ai 

4m. J. CMtf . V V . 1916. Utlv. 7> 

TIm oatlwr doiao for 
toractooQr iIm foBowHif 
doMkal oponiioB of ~ 

I. TW fnoral padlOMdl cavity b noi coQiam* 
iMtfod bya^jrlitkatiof Iqaor oouiiL ■• tbt roote of 
date toBag ovfag to tm tataio of the 
of iIm atorw to tbo poiiotal hkyn, 
«lw ait loag ia labor vHli aMoubfaaci rap* 
mktdmt bacioria la tlMir uteri, nuay 

of IJMS pollMflHit 

t. SiAmqtim dd l fo ri w amr bo doot tbroogb 
tbt taaM MW viUMat oaloriat tat tMMral poritoaoal 
cavky, or tlH MN«y May bt ipoaiaaooM witboat 
doapr of aloriM rapcara, at tbt tear ii la tbo dibu- 
iatiOVMal aad aot fai tbt ooatiactlk port of tbe 



Ank. 



ftkti. m 4» ij mi ( *t i*!^ V, ISO 



5. OaMaCal tad iaicatiaol 



port 
are 1cm 



4. TW abodt aad pott- 
ttoat art dcddtdly aiaiali 

5. SbooM iafoctka oecar, tbo Itoioat f ooad are 
pari am lie or am atrqierltoatal tiadttw wliicb 

to protect tbe orpui tfoiatt tlie 



r aalbor bcHovoo tbai tbt ( 

placa tbt daaical opiialJoa fa aH coaeo ia 
a tool of labor boo beta gbta. lu man 
■Bcral iiaiilnymii iboald redact tbt OMftality 
to al rliiin. aad glirv botb 



aMfftaBty 
aad ddkl a 
CH-Davh^ 



btltor 



Wood. H. C.t RvwicnicSoa of Ibt 

Wood repoffU a oatt to a gM aped 18, wbkb op- 
paroMly d tt d opt d foUoariag aa ii^ary rtoeiired 1 1 
ytart previoaiw. 

He caUft aucoiioa to tbe rarity of reported caaca 
of true cvcairatioa aa c oa m ared to taoat of dia* 
pbfiQialif bifaii. tad ii^piH tbt frnrtTtWHtT That 
aMTi caita of aiilitilta art bang aet nuokid 
tbta to tbt totttr coadfaloa. bteoaat of lack of 
iyplOBM, aad alao bictaii of tbt f aa tbat btrala 
it Mtncltlirt «itb atvwa traaoaa aad ttvttc pbyai- 
cal dbabOly arbkb ofUa tada to dtatb. aad tbt 
coatfiioa ia foaad poauaontak 

Bmmmitm, bt atya, ataaBy d ept ad i apoa 
coMHllal drftcu to tbt left balf of tbt dtapbragoi. 
or ut Itfi laag. or boib; bat a naal ptreeiiiagt of 
caaat are tbt reialt of tnauaa, or foDoar acatt ia- 
Itcdoa, aa a ranrit of dapiairiilna of tbt araadt- 
tf Ibt dtopbiapi or iaff <« tbt pbraak 



vat a Biaa oi 35, 



Tbe patient in Briodeau*a 
ouTfied and the father of tivo ddldrea. Re luid 
bad BO prior trouble lave a 
datiag froaa bb iafaacy. It 



right icrotal bcrato 
never troublod hiai 
ptratioo. Hb attii- 
botoa wore atroagly oMacaliat aad tbtre waa aotb- 
iog abaormal to tbt gaaltal orgaaa. Tbt tcrotam 
waa volonioooa aad anrawtric, tbe riglu ddo botag. 
nadi larier than the Icru Oa ptipatloa a pyiUofai 
Buaa was felt which moaatod ap to tbt tagaiatl 
caoal. The tumor waa aoa>redaablo. 

The caae waa rttagnnard aa tplp l ocrle adbtraat 
to tbe aac Oa optaiag the tuaior aa einagafod 
Buaa waa dJadottd abtwiag a flattcoed cord at iu 
aaifaot wUdi at im taagrttod a cacal hernia; 
doatr ttaminatioa abowtd i^to bt a utcraa with the 
fundus bdow and the aedt above, aad of aoraud 
volume. A tube of normal leaath dcptadtd froai 
its right extremity. Beneath the tube a aHgbtly 
hypertrophied but otherwiae normal tcttldt waa 
found aad covered with iu c p ld i 4y Hib . 
tube waa tmbtddrd to the left conraa of tbt < 
Tbert wore diaplactd witbto the volumiaooa bendal 
riag a otoraa da rolop a d equally to tbat of an 
adtUt wooun with Urge bat aUgbtty aqmotric 
fundus; two tubes; two ttatidra, oat toatwbat 
lander aad tbt ocbtr toulltr tbaa aonaal; two 
two dtfomt caaab: aad two roaad 




docided not to remove ibe utoma but 
to reocct the small teatide wbicb waa of Hltk use 
aad likely to cause paiafttl t cd d enla Ht uaed 
the uterine body to doaiag tbt iagaiaal caaal. fix- 
ingii by soturea aroaad tbt das. 
The author boa f^aad iS MaBar 



wiUi dtalioaa of 
aa o w ar abaoai al- 
attdbatca, bat oc- 
Only an 
of Uw 



There are no daftoht 



aad tbe pby«iral 



liicratore aad be givat abort 

thcat. He tbiaka tbat aach 

waya to aab|tcta of 

fadoaally tbty art p 

ity haw bad cbBdraa. Ia 

tbt atoraa waa doable. Tbt toatidea art maly 

aora»l; geaeraBy tbey are atropbltd aad to ai t tiaii a 

degcatraicd. Ia aoaao caata tbt atoraa baa btea 

coaipleied by a vaglaa npiaiag iato tbt aiatbra, 

wMdi oiptoiaa tbt faaat ofhlood bv tbb caaal ob- 

aarvod to aoaao patitau afltr optrtuoa. 

Hyatoraciaaar b geaerally todkaltd bat to car- 
tato caaca iatioa of tbe atoraa to tbt togatoal caaal 
wm aaftca. W. A. 



GENERAL SURGERY — SURGERY OF THE .\BDOMEN 



19 



Davit. L.: CMBfMaMlHM «id tt i i |iii l « «f tiM 
Optrartoa far lagalMl HanUa: an Aattlyito 
of On* ThovMHitf Mid fhw Hundrml Cmm •! 
th* MMMchoMtts Cwnwl UoaplcaL /. Am. 

M. Att., 1916, Lcvii. 4S0. 



Colcy reports j.ioo casM of ingdaal iMrnU with 
Icaa than ooe per cent l o cuf reo ce and aoMmg 3^383 
caaea of hernia of all kinda there waa a mortiltty of 
ai7 per cent. The author's analysis is based upon 
1,500 coQiccuttve caaea of infuinal hernia operated 
upon at the Maasadraaetts General Hoapital from 
October, lo^ to December, 1914- I>efiBit«l3r 
stmnfuUted hernias were not indoded bat caaea 
of incarooratioa withoot acute ajraptooa were 
covntcd. Thcae operations were |ierfonned hf no 
leas than mjhioIjt n¥i individual operators, 'ftere 
were 1,388 osalea and iia females. In 1,244 cases 
the herain affected ooe side only; in 256 it wss 
doable. In 88 caaea the hernia was direct and in 
the others indirect. In 69 cases the hernia was 
coaapBcated by undescoided testide. There were 
caaea in wUcn the blackler was contained in the sac. 
Tht ap|MfK**« waa found in the sac in 8 cases and 
waa leui ov c d in the comae of the operations in 46 
caaea. These were 7 cases of sliding hemin. Hydro- 
cele was present in 40 cases. In 50 cases there had 
been n previoos operatioo for hernia, with recur- 
rence. In the male cases the Baasini technique was 
employed 834 times. Ferguson 764. and H ah t ead 15. 
In 16 cases in which the hernia was complicated by 
ectopic testide, orchidcctomy was performed. In 
CO cases the undescended testicle waa brought down 
uito the scrotum; in one case it waa df oppe d back 
into the pcritoned cavity. In 9 caaea ordndectomy 
was doite in the course of the operatioo 00 account 
of tubercuJoais, gumma, or other Icaioaa of the 
testide. 

Spinal aiiaathfaia waa used in 89 cases. Local 
ansathesia waa uaed alone in 75 cases. There waa 
ooe case of rectal anesthesia. The bladder waa 
injured in s cases, with immediate suture without 
ill effect. The vas deferens was reported as cut 7 
times. There were 8 deaths in the series, a mortal- 
ity of 0.53 PCT cent. . ^ ^ ^ 

The author reports an unusual case with death, a 
man of 63 with diabetea mellitus, having a scrotal 
hernia and symptoms of severe cystitis. Under 
spinal ana II hf lis a suprapubic cystotomy waa done; 
it was then found that there was a hernia of the 
bladder through the !"g"«"«' canal. As the bladder 
couldjioc be withdrawn through the hernial open- 
ing, the inguinal canal was opoed and a stooe was 
found in the portioo of the bladder lying in the 
hernial sac The stooe was rem ove d , the in guinal 
canal repaired, and the bladder dosed about a 
snprapubic drain. The patient died of aepaia. 
Non-fatal post-operative c o mpHratio na of more or 
leks severity developed in 438 cases, or 18 per cent; 
some of tboe were trivial. In many caaes the gooh 
pficationa were multiple. 

In 158 caaea the wounds failed to heal bv first 
intention. In 93 cases the aepab was trivial, coo- 



aiating dther of a stitch ahacaai or oaora often a col- 
lectioo of seram wMdi required dralnlnf. In OMny 
of the latter caaea probably no infection waa prcaent; 
cultures were not nmde. In 65 caaea there waa frank 
pus in the wound, under 4 per cent of the 
number of wounda. Of the 75 caaea In 
tioo was performed with local 
d e veloped in the woondi in 13 caaea, or 17 per cent. 
Of the 89 cases b which operation was performed 
with spinal ancstheaia there were 9 septic woonda, 
or 10 per cent. Hematoma developed in its caaea. 
Complications in the respiratory tract occurred in 
1^8 cases, 9.2 per cent. Data subsequent to dis- 
charge were obtained in over to per cent of tbe 
cases. During the year 11 patients died of inter> 
current disease: 577 were reported uncouivocally 
well or cured, representing 76 per cent wnoae sul^ 
sequent history was known. 

The commonest complaint was of pain in the 
wound, espedally when working or lilting Two 
complained of persistent numbness in the mgwinal 
region. Of the others in the relieved dass, 17 
patients had no actual recurrence of hernia but a 
bulge in the region of the scar; 8 had marked 
varicocele; 5 were cured of the hernia for which 
they were operated 00, but subsequently developed 
hernia elsewhere; 3 had atrophy of the testide; a 
had keloid in the scar; i had a persistent sinus; 1 
devdoped adenocarcinoma of thie sigmoid; and 1 
was cured of hernia but had incontinence of urine. 
There were 6 cases of miscellaneous and undaasi- 
fiable complaints. 

Fifty-nine patients had definite recurrence within 
the year; ^ of these had double r ec ur re nce s; a are 
known to have recurred after the lapse of a year, 
making a total of 69 recurrences, or 3.7 per cent of 
the total number oif operatioos performed, and 8 
per cent of the number of caaea traced. There were 
6 cases in which there was <peBtionable recurrence. 
In a of these, rdapse was daimcd b^ the patient but 
could not be found by the examiner. If these 6 
cases are counted as recurrences, the percentage h 
raised to 9 per cent of the cases traced. Of tneae 
r ec u rre n ces, 26, or 3.1 per cent, followed the Paarini 
operations, and 34, or 44 per cent, the Fefgoion. 
In 1 1 J cases in females there were only 3 recnmnoaa. 
Of the 88 direct hernias there were rccurrcnoea nolod 
in 7, or 7.9 per cent, or 15 per cent 01 the direct hernia 
cases traced. 

The author condodea that postoperative conrii, 
harmatoma, and aepab are important factors in the 
incidence of recurrence, but the huter oon^iiicrtlan 
seems to play a lesser rAie than is fencralfar aaalfMd 
to it. A strikingly larne nuasber of naticnta ann- 
tomically cured complain of pain, probably dne to 
nerve traumatisou C. G. Hsivd. 

Upactan^ am 

An., 1916. Uvii. 4A7 



Lnchrop. W.: 
J. Am J/. 

Umbilical hanin ia about twdve tiaaa 
mon in women tlmn in BMn. In doing a ipactomgr 
the abdoosen b sdacd above and bdow and a laife 



INTIlRNATIONAt ABSTRACT OF St'RGKRV 




caa bt niMd bH«««i iIm kuidi. 

wfll ^hw M Mm of 

bt iwMfid. TiM iacWoa it 

M Um iMt aad m- 



0pfnuioa< TlMnCon It it tift to oowlMdc tiMt 



DOHMBHHIhI DqIM OBOOAs* vkBs to OH^MMt' 

kmkm iirfcw tbow tkt poMt, — d UtfwOmm li 
tWwobHcm. liilwoldMtMdio facion. Bd 



ri iImi tW wiMit UWOM of ti 
bt iMMvtd. TW doMi* b oonr Md 
«t «itb «i«^ caifot MttoTM, niaiorcad 
«IUi tUktwrai fit. TW aflwmtotaMM, If Iwniia 
iHt btM lipolrad, b i«i is btd for fraoi tifluoMi to 
I wiif §¥■ doyt; o twriiiitiag poitwt it ttmolljr 
bm. lftlp«aonraloMitmit,tlMo«iiciimbrai 



bMtlotbt bydncMoric 



porililMI fdf 

mm of I 



ibrai 
or tM dojrt. foUovod by the 
f or a l«w day*, it all that b 



TbcfvbaciaMofi 
b BHM bripf ol. ia 
•bom tba tbick vaM of fat 
Irmb ibc wrfari to tl» porta to bt n 

If tbt ofMrator to worli ia a dttp wpact with « 

of fat oa tacb lidt. Aoanatt tnturing u 

ia tomt of tbitt ottct by itatoo of 

a valaablttat- 




Mloa by wycb tbt diladtfit aia otticooM In a 
M91 aMamt bjr aa oval faKirioa of tbia aad fmt 
to tbt ittfti abdoarfnti waU, rtaM>vi^ the 
\ ' or ia a vertical directioo. 
: to, or at rifht «nidc» with, the deeper 
the thkkncM of vail down 
10 the fatda. aad from tbart iato tbt ahdomiatl 
cavity tbt diptb b aot paat aad tbt nptiilna 
aad doaiaf b awdt foiB|>aftllvt|y taiy, wbilt iaal 
doNiv of tbt ikia b aot dittcak. Tab alto ra- 
daoti tbt fat loaMwbat, tboaah of coaiw much Ich 
tbaa ia a rcfalar plaaatd aadnoo or Hpcctomy. 

CG. HtTo. 

0AOTK0 4J II 18IU IAL TtACT 

Cilatbura. IL. TMnipowrt^y. !.. aad Hamburjar. 
W. w.t TIm W t aor latarprolallao of iba Goa- 
trtc rate la Owtalc Utar. J. Am 1/ tu. 
1916. Uvm. 99a. 

Tbt patcfat aatan of the cbafacttrinic pala of 
ptptic aloor b a aMtttrof coatidtrable iiinrai ff, 
aad tbt aatboo tadcavor to throw toow atw 

IfbloatbtaiibM- 

Altboafb ttvual iavttliftioit (Htrty. Caritoa. 
LtMaadir) bavt daimrd that the aonaal gMtiic 
■■ma coa aot give ntc to nainJul MMOti 
that tbt vitcata art aol tappliad with pala 
laiitr fvidraca (Katt aad atdtacr) ttadt to 

da aibt fvooi tbt vitctr a 
la dhaiafahod tpMaiilittt aad that tbt 




Tbtlatatt thooiy of tbt caatt of pala b 

ia iatrniMmc laatioo (Htru) probably dat 

to oaMwattd pwitlthb ia tbt byptirtoak oraia. 

_ otntvat uaa it laiiofia oa oy cataacti 

BdtlaMa aad Daochtii bava loaad that 

add ttiiMlaiM jrtrittibift iltrta, 

Imu aaotit aadpaidag iato tbt 

daadtaaai prtrtalt idaaatloa of tbt pylorat or that 

tbt aktr aipotit aMia aorvt-tadiap ia tbt ttooMdi 

vaO, tbt Irritaiioo of wWdi by addt, acc. caattt 

pylori c ipaam and JntrfwiftT d (tttfic toaat. Tba 

authon art ladlaad to thb vitw. 

liunpr ttptfioMBlt bavt ihova thb to bt dao 
10 coatractioat^oa^ that ia, IwrtHiaalailna of tbt 

wbolt aHowatary tract had a ptriodic activity wbta 
aot illgliHi the ptriodt oooanlac tvtry boar aad 
a half to two houn. Caaaoo aao Waabbam far- 
ther found that the atroag ooatractioat of the Mon- 
ach wrrr invariably aoooaipaaiod by tbt 
ol the hunfv paag. Thb 
wbta the cootractioat ottaed. 

Tbt auihon bctttvt that tbt boafer ooatractioat 
have a direct beariog oa tbt pala ia ulcer aad that 
there b a dote aaalocy b etwte a the atate of haapv 
and the more plausiMe view that ulcer pala b «m 
to teoaioo. 

A aeiitt of expcrimeou 00 10 
with thb ia vitw; a detailed report of oae ( 
givta. Ia aO caatt with tbt oattt of atroat 
tiactioot the ptlicnl oooiplaiatd of 1 
varyiaafromafetBagofiwnBttitoatvtrac, _ 
paia, the ttatatioat cotdag oa whea the coatiacdoat 
reached thdr height Adadabtratioa of bydro- 
chloric add in atnogtht of as tad 1 
Utile or ao tfbct. Stroo_ 
mwffd vi g tro tit ooatractioat. Ia 
tioa of amyl nitrite cautod aa iauaadiata ctaiatioa of 
all coattactioo (or four houn, arramp aaitd by a 
feeling of estmne faint neaa In another catt, 
the in|ectioa of t$ mininia of pituitary tnraa 
caattd vi g proa t ooatiaclioaa to aot ia. 

Tbt aatbor't ooadaihNM art at foBowt: 

I. Tbt iadiag of ttroag c o aua c U oat of tbt 
atooMch ac c o wpany iag tbt pafai of fHtdc 
attaat to ooofirm t he idea that pala b dat 10 

a. Tbt maxked huager coatiactloat caatt pala 
fottfic ia a hy pt rirrii a b l t ww a Ml t n a of tht ttooMch by 
■t aad iacraatuM fcMngMtdc MaMBM. 
atrvat, 5. Tht co ac aplfaa tfct gMtdc pala b dat to 1 
abow doa will aiphfai aMay obi 

lag ftitfic alotr, vii., acbyla fMtrica. cluoaic ap> 



naadifilb. 



i faiitctloa of waah addi caattt 

(Liiaiaibal. nmu. Cook. Scbaddt). Ia pytoiotpatiH. aOowbig giaattr 

aa. tht aMtt vantd ruaalta aia laportod. daotdi 

atat npaitlag paia froai oij ptr ctai bydiaddoric s* Tht aiA|tctivt rriitf of pala 

add aad aihtn ao paia froai 5 ptr am hydro* aot aiciataiay proirt that add b t 

chloric add ia oattt wbcit akcn wtti fouod at but oMy be wtefpictcd 00 the bi 



bt a factor by re- 



to bt 



uir. 



of paia. 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



21 



prevent the dr 
tooas by ncvt 



hyp«ton«i«, ie., pain. 

occur : 

appiccublc cflcci. 



I of poin produriag hypet' 
the causative factor of Mich 

it) (he strength that it may 
>ui 0.5 per cent, cause* no 
P. M. OusL 



T. W.: Gnacric and Duodenal Ulcer in tho 

ll'ii It J., igiO. «v. III. 

From a consideration of two cases of his own and 
ol several othen in the literature, the author 
ooadodes that ulcrr of the stomach and duodrnum 
occur in the child in mien, being undoubtedly 
of thrombotic origin, the bacteria originating in 
the mother and passing throuch the placental cir- 
culation. In the one case whicfa came to post- 
mortem, there was no induration of the edge oif the 
ulcer but there was a band of adhesion extending 
to the gall-bladder, showing that the ulcer must 
have entted (or some time. 

No symptoms are vi&iblc until loss of blood be- 
comes manifest, cither through vomiting or its pas- 
safe in the stool, or by paOor or collapse from loss 
of blood. The treatment is that for arrest of 
hsmorrhage. K. K. AMunwomo. 



Bmutjm, 1 
Roaai 



I 



; F. H.. and Preidenwald. J.: The Value of 
Ctan-Ray Examinuiionx in the Diagno- 
ala of Cancer of the Stooiach. BuU. Johms 
H0pkims Hmsf., 1916, xxvii. jii. 

The early ^■f****** of cancer of the stomach is 
often very Mm*^ The X-ray method of diagnosis 
b probably more correct than any other means now 
in use. The findings, however, should always 
be taken in conjunction with the clinical findings 
before making a 6nal diagnosis. 

From the fact that the normal stomach varies in 
siae, shape, position, and the length of time in which 
it empties, none of these factors can be considered 
in making a diagnosis of cancer. 

The diagnosis rests upon changes in the peristalsis 
and irrcfular fiUing defects of tl^ organ itself. 

In cancer of the cardia, the cardiac orifice b usual- 
hr interfered with and there b a small or laife filling 
defect near. There b usually no interruption of 
pcfistalsb. 

In Iciioni of the body of the stonuch there b a 
pawirtcit ilbif defect and at this location peristaltic 
waves are interrupted, due to induration of the stom- 
ach waUs at thb point. 

There are two types of carcinoma at the pylorus, 
the annular type and the invasive t3rpe. The 
annular type produom obstruction early, the pv- 
lonts b thickened and lengthened and deprcssea in 
the center, forming a crater. 

In the invasive type there b a persistent filling 
defect at or dose to the pvtorus and tbb area b 
free from peristalris since the waves pom over the 
area and are lost. Thb type of caaccr may eaist 
for some time without obstruction. When obstruc- 
tion b present there b a bulging of the pyloric cad 



of the stomach on the greater curvature, due to 
pressure of stoouch costcsta *»■*■»— thb point. 

Spasm of the stomach wtt sowclimm cause 
penbtent fiUing defects. FnD doiea of atropine for 
one or two days will cause a relaxation of the 



In the differential diagnosis between benign ul- 
oeraUoB and cancer the following poinu should be 



1. In cancer lulesB the pvlorus b involved there 
is hyperperistalab and rapid emptying. In ulcer 
there b hyperperistalsb with pjriorospasm and slow 
emptying. 

2. Cancer may occur In any part of the ■***'niti'ti 
Ulcer usually occurs on the lesser curvature near tW 
pylorus. 

J. In cancer the lesion b surrounded by a lane 
invaded area, which b free from peristalsis. In 
ulcer thb invaded area u much smaller or absent. 

In early cancer it b often impossible to determine 
whether the ulceration b benign or malignant. In 
late stages where the growth b large the differential 
diagnosb b usually simple. 

In regard to negative disgnosis, if it can be 
demonstrated that there are no defects in the stom- 
ach wall, that peristabb b normal and that there b 
no tendency to obstruction, cancer can be ruled out. 
(>f 50 consecutive cases of cancer of the stomach 
examined bv the authors the lesion was found in all 
the cases, but in 5 per cent of the cases if was 
thought to be benign and found at operation to be 
malignant. G. W. GaiKa. 

Fortunet. D. de, and Cade, A.: A Caae of Gastric 
Cancvr with Secondary Cersbsliar involmnvnC 
and TcrminnI Meniniicic rnfMrailims \iam 
on cas de cancer pstiique avec a^«n SMsndaire 

cCrfbcUeuz et a cci d ta ts flBcaiagitii|ues terminaus). 
Progris m4i., 1916, p. ija. 

Encephalic complications arising from gfuuic 
ne^asms are far from common. The aotkor kaa 
had occasion to observe such a case in iu final 
stages and tmder circumstances which rcnifaiud 
diagnAus diffictdt. The patient was a man of 31, 
who arrived at the hospital in a very bad condition. 
.\ hard irregular tumor could be palpated extending 
from under the costal border to the lc>-el of the 
umbilictis. The general state as well as the stae 
of the tumor contra-indicated snigical intervention. 
On the second day after entering the hospital the 
patient showed mental disturbances, ana paretic 
phenomena appeared in the lower right liasb. Oa 
the following day all four limbs showed marked 
paresis. He died in coou on the fifth day. 

Autopsv showed a ne opla sm of the posterior 
wall of the stomach with submucous inblt ration, 
extending to tlw pancreas, with extensive lymphatic 
generaliaation and with a secondary manifestation 
situated superficially at the bnw pan of iht lift 
cerebellar lobe. There was a pufa l an t mariapMl 
exudate. The patient's history ihonad tkat tim 
had been fMtric troubica (or five or six yean bcfon. 



it 



INTERNATIONAL ABSTRACT OF SURGKRY 




Flf. I (GojrsMi.) 



Tig. a (Ooyi— ) 



odijr be attributed to 




of vaxioQS tectioM 
thomtd thai Hmy 



•Mlnriiudly Ind tkdr origis from Um futfk 
pliiB. W. A. Bum 



MHMAtL 

I.: A MpJMrartiB «f Root* Gmcio- 
tof wiwy la Yt GMUo-IaMffwiMny la T 

Sitf0 mM^ i«i«. liO. i«V 

GoyaMt potau ovt oMUio iBooavwiMott ia 
Rm? BMU^MmtiMw. vUdi is Mi pracdet kM 
ltd Mb to iMk* ft amliiauiaa. TlrfiMdttcttiM 
«■ bt wdfltlood from dw roogli fguw^ Fif. i. 
nuimwMi lit KhMM of ft Ron' opcniioo, ia 
vfidi tlw teUMiMl lynmi m* b_plftift iy moi 

Hi CMMmctioM of tUtiauiliaftl 

nmUhy. Fig. t l ip t m wi i Um ftotbor't 

of iMlift ■iTiiniiii ia T vydi ro- 

to Imalaaiatioa of Um proiiflMl oad 

of tbc ia|HMm fai th» nomi rt i ftt iu lo««« poiat. 

aad tlSiMMiM tiM dbial <ml to drift Moaal 



cm*. G. w.! M«dM«i a^ RoMto to Swtfwy of 
tb« Siomorti aMi tomdam. BiifftU M. J.. 
igt6, Inii, 55. 

Tbe priodpftl ouao of the fonacr Ufli bmcuUix 
in r mo ct io Bi of the tomftch aad Jatrntia m w— ftddo- 
m. dM nmnre ftlkalinity of ibt bodr Imviag 
oftca rodaced to a miaimum. Ia 

dawld be employed whicJi wiU ob- 
viatc f unber depleUoa of die ftlready l em en e d score 
of alkaUea aad baam ia dM body, aad if pomiUe 
the raaerve alkaliaity ahoold be iaaeaaod. Aa 
niffkal trauma Himiniahfft reecrve alkaliaity, iIm 
fonaer ihoald be reduced to a mlaimam hf the 
of the technique of a a o d ftm o dHJ o a . 
aitrooa oiido b the aaaethetic of choica 
becftam of iu cooacrriflf ocdoa 

la remctioB the operaiioa ahould be p e d onao d 
ia two atafm: (1) futrojcjuaoatomy. (a) i mec d oa 
after the reetoratioa of autdtloaftl bolftaoe. Aiide 
from proteioioe aniaat thriatOBod ftddoiii, frmt 
advaatftfe b f ooad ia caam of doobtfal difoHda- 
tioa betaaea caacar aad aker. DivUoa of dtt 



loop at iu lovoM poiBL 
ly tirii oMdwd the 
placod ta a a ■alipa rirtallk t 
wsvm roa aparaid aad kft 



Sit 



W b 
that li, the 
rmtrala 
lA,k ftctftlikaft 
aad ibi graaior or 
bftleMtk. W.A. 



stomach by the caatiiy aad Mftfiac of the cat o4fH 
widi oBoderata host HsriHasi afttaat pyoMak to- 
f ectloa aad caacsr mmnh aad prevcau Haadfa^. 
three iaiportaat coasHontioaft. 

Ia both dM im aad socoad aii«» the padoat b 
treated as thoi«h addosb imat inpsmtiat. by the 
adadaistratioa of water aad tabcataaaoas saBaa 
iafaaioaa, glacoaa ftad soda bicarboaau per racMm, 
aad Iqr the iadacdoa of alosp throagh the adaMa- 
tradoa of bromldm per rsctaai, aa it b oaty dariag 
slaip that the baiaaa caasad by acidaab caa be 



Weeka, A.t Os^inHal Pylarte 
J. Mt4.. t9t6. tiv, J 1 7. 

The author reports two < 
pyloric steaoab aad offers the 



C^.SL 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



»3 



I. CdogmitAl pyloric stOMiis must be ditn"«w1 
early. 
». It mutt be relieved by operatioa. 

3. Tbc operatioo known — KimiiMfdt't is by far 
tbe best, as it is tbe limplMt, qwlAett, and safest. 

4. A pediatrician shook! work with the mrieoo, 
in order that the baby may be properly watched and 
fed. 

5. Babies said to have r ec o v e red from this 
coadi U oa m edi c al l y were Improperly diagnoeed, at 
the tomor ooold not have been pracat. 

6. The amnthctist should be the best it u pos- 
sible to secure. 

PmkImc.V.: Radical Cure of Gaacarol the Pylorus 

(Core radicale du cancer da pylore). Pnnt mH., 
igi6. p. j6i. 

Panchet says that on making an exploratory 
lapnrocomy the canoeroos pyloric mass is sometimes 
observed to be mobile ind with few adhesions. 
In such a case pjrlorcctomv should be done without 
hesitation. When the pyloric mass is adherent to 
the liver or other neighboring organs some opera- 
tors prefer to make a gastro-enterostomy, while 
others, including the author, prefer a pyloric resec- 
tion. Even if it be only a palliative operation, t he re- 
sults are much better since tbc patients often sur- 
vive a year or more instead of only a few months. 
When such intervention u practiced in advanced 
cases there is always the risk of having to remove the 
colon, liver, etc.. and the mortality of these very 
mutilating procedures runs to 25 or 30 per cent, yet 
the greater ooeratory risk is worth while as it gives 
thepaticnt the chance oi living longer. 

There are five indispensable preparatory measures 
before and after openttfcms: (i) to assure evacuation 
of the colon by su c c essi ve bvage; (2) stomach lavage 
(oxyfenated water); (3) cleansing of the teeth be- 
fore and after operation, remov^ of tartar and 
spplication of iodine tincture to the guins; (4) to see 
that the patient drinks only sterile fluids in sterile 
receptacles during the eight days preceding opera- 
tion and the ei^ days following it ; ( O to train the 
patient in ro^aratory |3nnnastics which will pre- 
vent hypostatic coQgestXMi of the luncs. 

The author cmplc^rs regional a mrst hes ia preferen- 
tially t o avoid pul monary complications. The oper- 
atory technique employed rcinriiti of the following 
measures. 

I. Median laparoconv. In this the incision mtut 
be very imich tncrcasetl for the radical operation. 
The tranavcflw colon must be separated from the 
great epi p loon and poshed out of the way wfaQe the 
pylons, the tumor, and the great epiploon are 
removed; the cancerous psdorus is separated from the 

s. Ligature of the vesseb and section of duode- 
mun. In sectioning tbe duodenum tbc treatment 
of the stump is consolidated by the suture of a 
fragment of epiploon. Tha consolidation will pre- 
vent a secondary rapture of the duodenal sotore and 
guarantee against a duodenal fistula. 



3. ligature of the gastric vesseb and section of 
the stomach. The section of the pyloric portion 
of the stomach b done by thermocaotery. 

4. Implantation of the gastric stomp in the jeju- 
num is nuMie about 15 cm. from tne duodeiio- 
|ejunal angle. If the gastric section is very lom 
It can be narrowed down by some sotores. 

5. Treatment of head of pancreas. This is 
covered with epiploon, sutured with catgut and not 
drained. 

6. Gosure of the abdomen completes the opera- 
tion. 

Radiologic examination of such operated patient 
shows that while the stomach surface is rednoed to 
one-third of tbc normal, despite the etiormoos anas- 
omatic opening the functioning is fulfilled as in a 
iMrmal stomach. W. A. Bikjoiax. 

Eacudero, P.. and Pasmnn, R.: Decapltnckm of tbo 
Duod enum by Ulcar (Decapitadoo dd duodsno 
por ukera). Prtnsm mtU., Argent., 1916. iii, 47. 

The authors call attention to the rarity of this 
case, there being only one analogous case published. 
The patient was a man of 60 whose sjrmptoms sug- 
gested a diacnosb of duodenal stenosb which after 
further r adiologic examination was definitehr changed 
to peoctratiiig ulcer. During the operation wbch 
followed lesions of the retractile mcso-enteritic 
tjrpe were met with. The anterior wall of the 
stomach was found infiltrated. The small curva- 
ture, the liver, biliary vesicle, and duodenum were 
all intimately adherent. Posterior gastro-enteros- 
tomy was done. Postoperative evolution benn 
well. Miction disturbance and urinary infection 
arising from an old urethral affc<^ion necessitated 
an urethrotomy. The patient failed rapidly and 
died 00 the eleveoth day. 

Autop^ showed a cavity the size of a mandarin 
orange between the adherent organs mentioned 
above. There was a veritable section of tht 
duodenum as clear as if cut by shears. TUs cavity 
was empty. In the other analogous case whioi 
was reported by Meunier the cavity contained food 
remnants. W. A. Baxxiuii. 

Saralrnui. J. A.: Radloloitic Study la Saasa Qmss 
of Inmtinal Obstructkia (Estadlo tdWftf^ 
rn alKun<>'> • av.>4 de ob stm ccioo tatrslinal). Itm. 
Anx m/J . ArKcol.. toilK, iU, M. 

The disgnosis of intestinal obstruction is geacraQjr 
easy tmder the radioscopic screen when thm are no 
complications requiring clinical aid. Whenever tbe 
author b sure of the permeability of the psdoras and 
that there is no other lesion whatever that detaiM 
the ingests in the stomach he b convinced that there 
b an obstruction in the small intestine if nine boon 
after a meal remnants are stIO in the stoosach. 

Some particulars are given of the rndJolggic fiad- 
ingi in different types of obstruction. In 
invagination of the small intestine there b 
an absolute failure of the projection of the 
on the screen. The projection of the shadow b 




INTKRXATIONAL ABSTRACT OF SIRGKRY 



_ ■• lltt «biinKilM b coi»IHt 

Of Ml. In ill* ini CMt «t do WN arr ihr IwldNM of 
ibr bbnaili ommI dMaUi bi bolk »lirQ «■■!■■' 
ikMMatvmaik «i iNr mdof it. 14. or 16 Imw»; ud 
to %kf trcood «T trc ilw Moatt toiMttot to iu loM 
p«t, dhyh iftog a itovod o( b hi oyi li mtMm ^^ 
ffdwid in^Ktofy Mi bv iht tovMioirtoi. la 
itooair or Miboniic appvodidib there It tftqmt/lfy 
obMnKtkMi of ibe Uilfr pan ol the Qnim wiltwit 
vWbk •! Mdi tla« bv tot— tool rciaito. 

WImi cmmm or IbiocMMVi pifitoocol tuber- 
cotarii b a cooat of toloattoal obairticiloQ aa eciaaia 
of ibt biiWMb b pni^ct d at the hiiibi wberr a 
roiatrirtit baad or ibe badUanr p fO C OM obatruri* 
Ibt boMB of ibe toleattoe. CUmaMy tbia b oaiully 
abo«i tbt ton portioo of tbt ilcom wbicb b OBoat 
tnqmMh ibe tile of tbb Iwfeo. 

la obMrvcttoa, 4m to a Laae't Uak. ibe diagnotb 
bv ibe tcreta b boaad 00 ibe cctattoof tba bbmiiib, 
amb dtaBtocoOMM of ibe csomi downward and to 
Ibe fifbt tide. 

Wbca tbt ecuaia b pio da ce d al tbt bvil of ibe 
tmcmm tbe dtoooria b Mt ahv^ya ooqr. aa tbcre 
wt oibv aflacnoM barfdaa tolMtto 



ibt laagib of itoM totarvMlag bat 
aypiiwt and ibt toatlmttoo of u 



vWdi art capobit of abowiat tbt 
lologjr at ibb poiat (oaciua BMbOa, aCc). 

W. A.BaaiauK. 

Oanab W. 1. 1 totaaaatBtnlaa. Ctoatf. /. M.irS.. 
1916. li, sIL 

GaMt ihrta a aiatbtical iwiew of 45 caa» of 
taMMMiplioa to aaMR cbiblrai, occuriag in ibe 
CbBdraa^ Boapiial of Toiaaio. 

In tbe actica 17 caaea wore irredadble; is of tbeaa 
wvre mated bjr faatctloa aad tnatlnmoab aad a bgr 
ataipit icctoaqr. All diad. Tweaty rfgbl CMaa 
woaa ftdiiciblet s wcro redu c ed wiiboat opavatna 
aad aB mww ad. Of tb a aS caaaaiS were mAr 
aad 14 aacovcfod} 10 were redaoad witb du* 
a ncovMod. GalBe taraH tbaa 
wbaa tban b ao ai^a of localatd 
BO aMrbad cadaaM, ao tofactioa of 
, lajrer or otbar aifM of iajary. Tbe 
wBI tbett dapaad oa ibe p rea ea c a or ab- 
of tbaat factooi. 
Tbe caaaaa of daatb are abock aad toavmia. In 
tbta9laialcaaaB,ijdbdofabock;of tbcae 11 bad 
laaa deat. Ov tbt 16 dytof from tonnato, 
I of ptritoaitb fve dajra after optmtloa: tbe 
14 iboaod typical typtoaw of toaMBia of 
obnsactna, iu 




Mood^nanra fal 
. MT^mpaltbia 
proitoat forowd to tbt ■aoni 
aad tbat tbttoaflir tbtobaci 
aMwe cstcaalvt tbt daMtft 

ttr tbt prebabMty of a taiaaiia Galhe 
a tbt «t of a bag rabbar caihctcf fNuoed 
tbt ractaaa, atoai tbt coioa iato tbe Oeoai 



tbbtaito to baa 
above tbt obatsactioa 
obttiactioa paniMsaad tbe 
to tbt iaitatiaal wall. 



above tbt 
ibetoala. 
Tbe prebabMty of 



toaitrd 



b to toverae raiio 10 



tbtooaatof 
()f tbe 

16 r e c ovarfaa. it leeaived iieataiaai wiibto twenty- 
foar booia; of tbe to fatal cat at. ta dM not rtotiire 
irtaiaicai uaiU after tweatx«foiir Iwara. Paitbar, 
tbe loi^rr iba toterval. ^^V^gf^ ^ prtbobflkjr 



However, atvani tonaacat aie died aa 

to Ibe rale wbicb daaMaatfato ibai ibe madhtoa of 

tbe bowel caaaot alwaya be foratold from tbe btaiory 

la early tHaganab Hea tbe oalf booe of lai- 

rvemeoi in ibc ttaibtfca. Tbe c o a d Ml ea ocean 
hralihy children of oodcr oae jfear. p rec e ded 
usually by digcative dbturbaacaa. Tbe attadi 
begtot with acute abdominal pain aad oftea 
tog. followed abortly by the typical tlool 
of BMrrly hUnxi Malocd mucua aad ao Csoaa or gaa. 
On examination the abdom en b dacdd aad uaoally 
the taatagt tbapr tl tumor caa be fouad; in t of the 
•erica, how e ver, no tumor waa fdi. With tbcae 
•vmploaaa no delay thouM occur to allow of pallia- 
tive treatmeal. 

The rational couiie b immediate laparotoaqr aad 
reduction if poiaible. Tbe operalioo aboald be of 
the thortcat poiaible duratioo and with the 
amount of intcatinal manipuUtioo or 
Intravrnout tranafuaioo of too to mo cda. of 
normal talinc tolutioa b oaed during operalioo aad 
100 ccm. are introduced into the abdominal cavity 
upon cloture. FoUowing operation. hypodenaoc> 
hrtb tboold be employed to maintain the aopply of 
dttlda. P.M. 



VolTulua with Scraagulacad iniaatlae; 
ParmUieni Dactaa Oatpbato-OBtarlrua (Valv«- 
In* nut straogelatiaadtaot; ptnitiiormdrr huctat 
oayhahMfUtlcea)- MUr. a. kUm. CAtr.. loiO. sda. 
t6$. 



la a caae nportad by lititantr iIm patient had 
nrauAotia w bi c b aagatated appeadicitla. The diag- 
Boaia, how e v er , araa very doabtf al aad the patieat 
waa pat to bed aad Heated tor foawatatioaa. Aa 
caema pve a good atooL Witato a day or ao. bow- 
ever. Ibe tituaUoo auddeahr changed. Tbe lean 
peraturc rote to j6.a* pabe. 100. Tbe pelitat 
bcgaa to voodi and ibb coaUnued with evidaat 
facta to tbe vomii. Tbe rlltganab wi 
waa advited. Oa opeaiag tiM 



opetatioa 



aad part of tbe ctloa waa battooatd op lowara tbe 
aaibelrm aad ao aaacb twoSw tbai it wat ready 10 
bant. Moraover it waa twitted oa iit aab for 
aboat 180* aad tigbiiy aacomptaaed by aceid wbidi 
reatricted it aad panad oa toward the awbJIicaa, 
Ugat urea were ap^ied aad tbe awoOta aau 
for aboat s caL, wImi tbe feat partly 
Voarftiaf c ea tjaa a d during the operatJoa. wbkb 
bad to be abaads 
Bttiaai htrtait wpjdhr q 
ftlan foar boan after 
abowed tlmt tbe cord paidag aioaad tbe 



owing to ihc difbndtita Tbt 
y cyaaotic aad died of bean- 
tor tbe operatiea. Aatooay 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



^5 



WM the remnant ol a peniMcnl ductua omphaio- 
cat«rkttt which «a» not in communioUioo with 
thr inmtinc. 

Ill cummealiai on thit CMe. lldmer Mate* hit 
beliei that the abnormally developed maeotery of 
the fint pan of the colon |ave rise to the volvtilat 
in tbb Mction ol the intc»tin«; the perustcnt ductus 
onphnlo-^Btcricnt caused the stransulation. and 
as more blood and eicrcmcnt became dogged up 
in the intestine the strangulation became narrower; 
this o( itself caused a further increase o( stasb which 
was extended to the lower loops erf the small intes- 
tine. 

A soootaneous reduction of the volvulus was not 
pomible and when an attempt was made to rectify 
the condition by operation the heart failed, death 
resulting. The question arises in this case whether 
operation was indicated immediately upon the first 
signs of vomiting. In view of the fact that shortly 
bdforc this there was a free passage of the bowels 
and also that the general condition and pulse were 
good, the diagnosb being still uncertain, Meissner 
nail up to thtt time refrained from operative inter- 
icfcnt-c. 

With regard to the clinical aspects of this case, 
in a pathoiogic-aoatomical sense it is very interest- 
ing, not only liecause of the volvulus and free 
ntesentery of the ascending colon, and because of 
the ductus omphalo-entencus itself , but particularly 
bec au s e of the anatomical condition of the commun- 
ication of this ductus. This condition is peculiar 
and rare. Persistent ductus omphalo-entericus 
is of itself no rarity, but that the site of communica- 
tion with the intestine should become obliterated 
and membranous, is a rarity. .\s a general rule 
it happens that the ductus when persistent becomes 
enlaqped where it joins the intestine and communi- 
cates into a Meckel's diverticulum. This did not 
happen in this case, but rather the opposite. There 
was complete obliteration of the lumen against 
the s ca r red and shrunken intestine. Moreover, 
although ordinarily a Meckel's diverticulum rep- 
resents the remnant of the rmbr>'onal condition, 
in this case the ductus remained. it.<i communica- 
tions with the navd and intestine having become 
dcatrixcd. W. A. Bar. wan. 

Bnetnian. J. R.: Coogenltal Deformation and De- 
funct kmaUancioa of the Caudnd Ileum and 
Coloo. /. Am. M. Ait , tqtt>. Ixvii. r>4;. 

Owing to irregularities in the fusion of the meso- 
colon desoendens to the mural peritoneum, trans- 
verse folds or septa are devdoped and small para- 
cokmic fosse are formed. .\t the lowest levd of 
normal fusion, that b, at the proximal or cephalad 
end of the sigmoid, a distinct band, marking the 
edge or lower border of the fusion, tciben the sig- 
moid to the abdominal wall. TUs *»««»«*lftf mupn 
b the lines terminalis. which stands out conspicu- 
ously when the sigmoid b drawn vent rally, giving 
added dqMh to the reccssus interrismoideus. 

A similar fusion of the outer laimna of what b at 



first a free and loose mesentery of the ascending colon 
with the contiguous mural peritoneum abo takes 
place on the right side. Esoess of thb fuiioB givet 
rise to the condition noted but not explained bjr 
Byna Robinson and observed with great freouency 
since, the condition in which a longitudinal plica of 
peritoneum seems to have been ptilled up from the 
bottom of the paracolonic trough and fuse<l like a 
patch on the lateral surface of the colon somnimn 
as high as the tenia libera or median lonffiiudinal 
band. Inequalities of normal fusion on the rifcht 
side give rise to transvene bands or folds dividing 
the paracolonic space into fosse as on the left side. 
Such transvene folds are so constant as to be con- 
sidered anatomic. 

Frommer. Curschmann. and Concetti recognijcc in 
the elongated, sagging redundant sigmoid a per- 
sistence of the ffctal and infantile condition in 
which the mesentery is broad and free and this 
portion of the large intestine relatively long. 

There is another important embryologic factor in 
the etiology of sigmoi<lal stagiuUion, this being the 
presence in the f<rtal and postnatal abdomen of a 
fold of {xrritoneum extending from the mesentery 
of the proximal sigmoid downward and outward in 
the direction of the internal abdominal ring. Thb 
persbting fold takes the same course as the plica 
vascularis of the descending testU or ovary. Per- 
haps the postnatal fold on the right side of the ab- 
domen extending from the mcsenter>' of the termi- 
nal ileum to the gcniial gland, which has been called 
the ileopelvic band by Lane and which in the female, 
may by traction on the appendix be drawn up aa 
the appcmliculo-ovarian ligament, is but a remnant 
of the very conspicuous fcetal fold of peritoneum 
which is drawn out by traction of the inguinal liga- 
ment on the descending genital gland, the inguinal 
ligament becoming in the male the gubemaculum 
testis and in the female the round ligament. 

No doubt the principal factor in the arrest of in- 
testinal contents in the sigmoid is an *qatomtr one. 
In many indiN-iiluaLs. {>articularly in the newborn. the 
sigmoid l)egins with a shari> turn upward or oblique* 
ly to the right and upward from the linea lerminalb. 
Freoucntly there are other sharp angulations, as in 
the lettcr-M sigmoid, rather common in the fortus 
and adult. Occasionally a sharp curve b seen at 
the third sacral vertebra where the sigmoM foea 
over into the rectum. 

Stasb of excrement in the sigmoid beytmd phirrio> 
logic limits leads to colitb in thb part of the large 
intestine. Ulceration may appear as the result of 
long retention of colon contents. Infiammatioa of 
the mucous membrane b a nattiral result of stagnn- 
tion of bowrl contents. The scnaa reacts to the 
irritation of high-grade locaHaed dhCcaiion: a con- 
dition which may be caOcd ooHtia iafiltrathrm 
chronica is estabasked; fixation adhesions of the 
sipnoid peritoneum are almost constant sequeb. 

On liberation of the sigmoid from the restraint 
of such irregtilarities of fcetal fusion, the return of 
more neariy nomul function b evidenced frequently 



>A 



nrmiKATioNAL abstract op surgery 




«f inf octri ud riiiniMltoml tp- 
ptadte avf U MiplaiMd ratioMlljr bgr iMnriaf tiMt 
Mfora Ammi ocout Um tfiMMu btnNMt cngltt 
teivwa tW tothKbm piiliimmi Mffocat of the 
CBcal ■iwnnr Md tfit ihitiwiriiil vaD. 
Fatal fwte Midi md BMibffUM M a nile kbow 
of faiCaHBMiftoSt M appanmlj ilfiHfH 
aad iMvt tkt aypMwaiict of thin conocc- 
TW dioBMaow aiimhrinr of peri- 
caiUior p cii ty p Mh iati ftaTaflariB adby ■byndant. 
iOMMiilin paiaMi fiw i ii ia i vmnIi vMch. it ahovlo 
ba aatad, cownyoad ia tMr cmom. divitioe, and 
dblfibalioa villi tW braachci of tke ilaooolic artary. 
Hit vaacalar vol of appanatly datariwd parito«- 
oHoBf if oWt ba coaiplaialy laaMvad 
loaviM a raw blaadb^ twfatff, TIda is 
r aa aiair of praaatal or pnaiaatai liypcr- 
•■mI fft^«^«^»^f^«^ 1^ laactioQ of 
to initaiioa oflaa bagbaaiat in an 
of tbo apprndii or 




It It rare tbat a chraak appmdidtia b not aa- 
aodaicd with tUa p a rirn H lb waibraBnaa vaacnloaa. 
Tha raaadar vcb of BMaUwaaow paricoBtIi aiqr 



dUocate tba apficndia vcradlonnb aiid lotailara 
«ilb iu dniaagc; bat bjr viruw of ita looaa dlapoii- 
tiaa oirartba paritoaaal anfaoaa, it baiag tba byoar- 
■■k t«alca aaraaa Itaalf, It ia aoi ao oftaa loaad aa 
a daforadag factor aa ia tba fold or baad raaoltii^ 
dMia of fatal paritooaal forioa. Tbe 

U tba aaoHMa of farioa caa ba brokaa down 

bar fawa a x ^ ^, ^^» 

baiag alBMat avaacalaiv tbajr do m( nadiljr taforat* 
To aitaaipt to atiip off tba vaiadar awiibraai of 
' " ' aaalla ia mv adhrajon 
tba dhririoB of tba wbita fwioa 




Aa a aaaaa of prawifaig faoal 
tlva aBpaadUtia^ tba aatbof com 



iafiaabadbarfoM. 
CCBavn. 



of Ptaeal Wamla la Sap* 

1 6. til. 



^««« U J . toi 



iatabia 
tba 



local 



Tba aia of tba «aMl>«p>ltlaf or ICcBonMgr 
ba laya «■ |dva a battar poau 
oparativa woaad, afpariaBy if abwubin aboald 
TbaaawBaatbaaaaMKbtapiitaad tUa 
aDoa aa aracb of tba aacam to 
adbaiaat to tba adpa of tba woaid, aa pro- 
of tba cccviQ thfougb tba wound may caaaa 
afacaliitttla. 

Tba tfaatmaat of tbe uum^ of the appaadli, 
abaai»ar poaribia faivartlai tba ataasp aad aalaf 
aa abaoibabia par i a i t rinj aotvre of caifat, ahraya 
Ifttlac tba appaadix with catfut. A tcooad paraa- 
atsiat mtore or a few intarmptcd aotoraa of catcat 
aia aacd for idafofcamaat. In OMaa ia wmdk 
paritypbliila ia praaaat to a BMrfcad dapaa aad tba 
haad of tba cacam baa bacoaie ao tbirtaaad by ia- 
ftaminalion that Inverrioo of the Momp la la^Ma- 
liblc. ba advitcst tuminc down a fold of thlrlraaad 
peritooeal roat. Ufaiing the stump with catfut, aad 
thea covering It over with tha cuff tied fav catgut, 
t. As to the ouaatioa of diaiaaai, soft rubber 
tubes are used aaa thoaa of laiga cawMr. Thry are 
placed as far as pomJbla away from the head of tbe 
CBCum, are shorteaed eariy. aad rem oved ia a* 
seven days, no laxativca bdag givaa maaawbii 
In Ss3 abdominal caaaa fai which dralaapi 
uaed tbe author aientions three caaea ia wWa i 
fiatula davelopad: one following a pyoaalpiax opera- 
tion wUdi healed spontaneously; aaoiher la tbe 
drainage of a larga appaadioaal ahaoasa, which alao 
healed spootaneooily: aad a third in a case of rup- 
tured appendicitis with aeneral peritonitis, which 
required aa operation to doae it. In lUa third case 
he b of the opiaioa that because of the aacaarfty of 
gaatiic lavage ovary three hours for four days, tbe 
traaau to tba bead of tha aacam by the tubea waa a 
factor ia tba prodactioa of tba fatala. 

W. D. Paiuiva. 

Brock. C. W.t A 
of tb4 
OM., 1016, 

Tba aatbor daarribcs a moUbed bUkattca opara- 
tioa for rmactioa of the rectuns, ia which tba opam- 
tioa b parf or a sad over a proctoacope or rooad bOlal 
of wood iatrodacad throMb tbe htawa of tha pro- 
lapaadmaaa. Tbe gut aadtheaupportiog core with* 
ia are held in poaiuon by tying a piece of rubber 
luhii^tor haagarao taadoa arowad the aack of the 
prolapaa Jaat iwntH* tbe aaal amnia. 

TUstacbaiqaa fadlHatia haadUi^of tba tbaaaa 
with a caia ia rapidity; tbe aatarea ara aaaily plaoad 
aad BMia aa aocarau appfuaimatioa of tba boaol, 
b coMJUatly aadar ooatroL 




Brown, J. Y.t Tha 
AaoaiatlM 




Am. M. Att., 1916. bvii. 4M. 

TW aatbor baiariactad the right side tor arUicial 
fbrtbafoOowiainaioas: 0) Itcaaharapld^ 



GEK£IL\L SURGERY — SURGERY OF THE ABDOMEN 



«7 



made. (>) It adniu ol Immwtiate and proper 
drtiiuife o( the dinended bowd above the obetmc- 
tioo. (j) It coMpletflIx MKhMlea the large bowd. 
(4) Subsequent noottUmtdfom of bowd oootinuity 
csD be moal readily performed. There b compara- 
tJirdy 00 odor to thie discharge from a right'dded 
aaua. 

The technique of the operation b aa foUowi: Prior 
to giving the anaesthetic, the stomach b washed until 
the water comes bade dear. Under ether or gas. 
iaddoa b made thnmdi the outer border of the 
right rectua mnade. The cecum b located and the 
small bowd b pulled up. damped, and cut across 
two or three inches above the Ileocecal valve. One 
half of a Murphy button is fitted in a good-stied 
rubber tube. This is inserted and " purse-stringed " 
in the pradmal intestine. A tube of t he same size is 
neact ioicrted into the distal ileum and through the 
ileocecal valve. Thb b hdd in podtioo bv a purse- 
string suture. Both the proximal and dtstal ends 
of the intestine are brought out and fixed at the 
lower angle of the indsion. The wound is closed 
in the usual manner. The proiruding bowd and 
tubes are carefully surrounded by gauxe, and the 
stomach b again washed out before the patient leaves 
the table. The tube through the ileocecal valve 
gives exit to the gas contained in the large bowd, 
whereas the tube in the proximal ileum drains the 
small bowcL C. G. Hcyd. 

Scooe, H. B.: A Trcncment for Pruritus Ani. Bill. 
Jokms Hopkins Hosp., iqi6, xxvii, 243. 

Stone gives a preliminary report on his use of 
alcohol injections in the treatment of this condition. 
The method was suggested to him by the value of 
the injections in facial and other forms of neuralgia. 

The technique of injection is quite simple. The 
area in which the itching is complained of is care- 
fully noted from the patient's docription. Under 
generd or local aneatheda, the infection U then made 
so that thb whole area b aiuestbetizcd. In nearly 
all the cases reported by the author a locd ans»thet- 
ic, usually novocaioe 1 per cent, or quinine and urea 
bydrochloride 1 per cent, was empIo>'ed. Thb 
form of anesthfda proved to be quite satisfactory. 
The syringe b filled with dcohol, 95 per cent, and 
the nnul fine hypodermic needle used for the in- 
jection. The needle b carried entirdy through the 
Ain vertically and then inclined sharply to the side 
•D that it lies nearly paralld to the skin awface. 
When the needle b p rop erly inserted in the subcu- 
taneoos fat. it can be moved fairly fredy from side 
to side under the skin and can be fdt moving with 
the finger placed over it. If thb freedom of move- 
meat blackioc, the ne e dl e b probably eagaaed in 
the coriom, aadl if injections are thus made, iloaghs 
may be expected to restilt. With the needle proper- 
ty placed the whole area invdved b injected, eooogh 
aloBhd bdng used to tmderlav the area thonMrnh^^ 
The injection may be carried up to the marpa of 
the anus, but the author states that he has never 
injected the and cand itsdf. nor has he so far had 



reason to believe that thb would have in^Moved the 
results. Of course, bdore any iojectioo b made, the 
sUn b cleaned up as for any other operative pro- 
oedure. 

Thb method arpiwnpHshss practkaOy the saoM 
thing as the operative treatment for pnnitas aad 
b indicated in those cases of great intOMity la 
which the usud measures fail. It has certala 
distinct advantagea over the operative procedures. 
It b safer, and there b no undermined skin with 
impaired circulation, with a potentid dead space 
under it. in an area iropoedble to keep dean. It b 
quicker. It entaib no dressings, stitches, or other 
post -operative annoyance to physician or patient, 
and no hospitd expense. It u quite as likdy, the 
author believes, to be enduringiy satisfactory, and 
presents no greater possibilities of trouble. 

GeotcE E. BntaY. 

LIVER, PANCREAS, AND SPLEEN 

Fowler. R. S.: Echlnococcus Cyst at the Left Lobe 
of the Liver DIacharftIng Into the Left Hepndc 
Duct. Lami Island M. J., 19x0, x, 317. 

Operation for echlnococcus cyst involving the 
bilisury passage b very rardy done; the rupture of 
such cysts into the passages b equidly naooouaoa. 
Symptoms of such a condition are those of sodden 
blocking of the common duct accompanied by pro- 
found collapse, i.e., severe pain in the qtigastrium. 
chills, fever, and jaundice. The diafaonis only 
possible when cy^i dements are recognised in the 
feces. 

The case reported was that of a female, aged 
21, who gave a hbtory of recurrent epigastric pain. 
nausea, and jaundice for the past foor months. 
Examination showed marked tenderness aad rigid- 
ity over the right upper abdomea Operation re- 
vealed intense inflammation of the jnll-oladder and 
ducts as wdl as locd peritonitis. The gall-bladder 
was filled with fine yellow sand; the walb were 
thickened and inflamed. Drainage was instituted. 
Slight jaundice with slight epigastric pain persisted 
after operation and recovery was uncventfuL 
Two weeks later the sjrmptoms returned and a 
second operation was done. Many adhesioos 
were found and the gall-bladder waa mnich diiteaded. 
All the ducts were greatly enlarged; the f'-r-nm 
dact to the dxe of the dnodenom TIm gall-blad- 
der and common duct were iadsed with escape of 
thin bile and bilestafawd meaOwaBoas decritas. 
The duct was then flushed with saKae aad aiimerwai 
pieces of thick, green memhraae were rem oved from 
thb duct and the Idt hraatic dact. 

Owing to coUapae, tae ope ra t i oa was speedily 
coiapleted; a fenestrated tube bdag placed ia the 
left aqMUJc dua; one in the foraawa of Wiadow; 
oae aear the junctioo of the two dacts; aad oae ia 
the faU-bladder. 

D^Hy saline irrigatioas aeie if c naiplJihiiil throagh 
the tube in the dnct. waridaf out varioas sawaats 
of the detritus, and the draiaage tubes were grade- 



IvnuVATIOVAL AB!rrR\(T OF srRGFRY 



TW iiiilwiB^cal tip 
•all bK — inffktn cyiu. R i pt td 



MOOUith *n«i«in|( no 



cy»i 



ol iW MmIi raBtd to ilMw Mjr 



•itimc aliuui aad Milag kmnUy. Tlib dii- 
MctlaiMMMctaadbtlMviorof th» ■hdnaJMJ 
ly tejwid boiwlMd by tW fact tluu oot !• Ihtrijr 



P.M. 



I.Itt AaUMM«IOMMitaNiMI«f ll«^l- 
;Vatt laiJIrarina ooro fffcurai* drl 



Ml. 

TW Mrtbor mpotu a cMt la a hub. s« y«an old. 
«l a p«raliM ahtoHB of tW Ihror ■■ptyhghtothc 

iW palkM^ aiHval at iW iMipilaL Hepatic puoc- 
i«fv mm doM aad about a iter of put launcdtatdy 
«illidm««, folovwl bv tejactloa of diloriiydrate 
of MMtlM. IW palWai. bow ii v tr . mcmmbcd 
ibr foloiiiat ^ *<M ^ c— dhWi «a» d l tcovcwd 
at ibt aatopqr. 

Tbt aatbor itf«a to tbe gicai rarity of thb tcr- 
MfaMlioa of btpatic abiOMa. In Rmdu't Eanrrlo- 
ptdk DkdoMiy oat of c6j coUcctad caaca of di»* 
niptcd bnatk abnoa oa^ j are aotad aa dbcbarg- 
liViBlo tbavnacsva. latbtaotbor'acaictbeoom- 
vilb tbe veaa cava waa tbiovfb the 
OM of tbe braacbea of arWdi ap- 
tbe aeiibbafbood of tbe kafam. 
W. A.BaBiou». 




of dM Uw (Ueb« 
bf» mktt Sc b — » Mte i 
r). Ank. /. kUm. Ckir. 1016. crtt. 509- 

lieb aayt tbat tbe <lipaifeiil of war »urirrry in 



bad to be valeonMd waa the »uriirry of 
iajofki^ AO aaig e o ua wcm 
to tbe fiou «kb the coavictioo tbat abdoadaal 
■ uold Boi aa a geaefal rule be operated 



«na. Tbe eoylag of McCormac afier tbe Boer 




that **all ibow. sbot thnmch tbe 
will bvr. i( Id aloae. and wiU die if operated." bad 
cwMW i propcftv. 

' laporu pdbWMdfai tbe baglMdaf of ihia war 

to coaim tbia coavktfcm. Fifty aad even 

ly per ceat of abdoadaal injurio were reported 

caaoervative twaiawni, How- 

H waR Moa doraaad. Boeblcr 

^: OS per c«at dbd, tbe iwt wcra fai a bopl«a 




by 
of oparatioaa for 
ialariaib Tbe mat pecaHaifty 
ktbecil 

'••^ -.w, 

leii pktanaf CMlafai dHtb, 10 wbkb tbcy Mtrmmbed 
wkliaadar* nifciii «^inii<*'anboi ihrotightba 




aad pulb tbro^gb, aot bocaaie bit preMuaable noai- 
acb «hu( ha» baea treated ceaianrativdy, bat ba> 
cauMT M» ■liawaiaty caaal baa aot be«i lajafad. 
The a(ber dha, biciaii be baa a petforatad woaad 
oi the fttooMcb or tbe fntrttlne. 

It b oftea aHefted ihai iun»boi wound* in tbe 
upper abdomea bave a murk better progaoiii tbaa 
ihow bencalb tbe ambilicu*. Tbrre b audi a 
differrnre. Tbe pragnoeb of abdoadaal guaebot 
injurica in tbe field boqdial depeada, in Ueb'a 
opinion, upon whether or not the alimeatanr caaal 
baa been perforated. In other word*, tbe tanat of 
peril oniti* dominatca the tituatioo. Sbota in the 
upper AlMlotncn. bowcvcr, have nore dance to 
■void the tntir«iinal canal than ihote In the lower 
abdomen. I( only thow thott which have injured 
the alimentary canal are cu ne id qe d true abdomiaal 
injuriea, their prognoeb with ooaaervativr treat- 
ment becomes bad. 

Uek beUevci that the UMMt important aymotom 
of peritoaeal irritation i* the relies tcaaioa of tbe 
abdoadaal wall. Thi». however, b found la other 
coodiliom and in all doubtftU caaca one laaM faKb^ 
widen the wound, and examine. In Uek'a Md 
hoapital service during the first foaiteea aMMttba of 
the war. 2.5 per cent of tbe wouaded bad abdoan 
inal gunabot ln|urica. Of ibeae ^ per ceat <fied; 
othen were tranaferred to baae boqiitala. About 
oae^Urd of the noa-operated caaca cvceltially 



Gaaabol injtiriea of the liver give an apparently 
favorable prognoeb similar to injuries of the 
ahdoBirn wbai treated coaaervativdy. Ueb' 
obe en red 17 caacs in which a apoatai 
of Uvcr guaebot iniury oocarred. According to 
Uek'a e ap eriea c cs it appean certain tbat the 
modem email caliWr bullets caa pass through the 
liver from a much »bortcr dbtaace tbaa i.mo cm. 
witboat effecting irreparable baroi. Tbe diakal 
aapect of Uver gunabot iajuriea varba foadderiblj. 
Smooth, coauplctdy peaetreting ahota cad awat 
favorably. Taageatial ahota arc Icaa favorable. 
They are aiarilar to tbe tai^rniial abou of tbe ekaO. 
Uek dvcabbobeervatkasof aoawcaeeaia which 
dear liver abou coayMcatad vbb lajariea of tbe 
ydaey. etc, healed ipoataaaoaaly. Ahaptlwr 
be aaw oaly 17 Uver iajurie*. thrK 
11 Dcr ceat of tboee eatcrinc with the 
abdoadaal giUHbot iaJaiy. However, be 
Ihrer waaada aia aaorr fieqaaat, alace ia 11 
iad caaes which came to autopav j aboand Uvar 
ialarba aa wdl. Li>e^ woumb arr geaenJIy 
fa a cw a iil a a t witb other ahdnarfaal lajarfea aad bi 
Tbole^ atatbtks of soo Uvcr waaada 117 bad coa- 
comitant injuries. In the 17 caaea oba er ved tbe 
dhgnoM* wa» made in ij witb ccrtaialy. ia 4 by 



aperatlvc iadfaifi, la a Iqr lectioa, aad in 7 by fu 
oaliaw. Tba oatiow «f gdl fai tbe wound waa ob* 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



»9 



tcrred iajif per cent <d Um nm, Otber otMcnrcn, 
aach as Edler, give a higher ftgnre. 41.3 per cent. 
Lkk't mortality wa« loa than that ol other re- 
porters. He loat 8 patienta, »g^ per cent. Korte'i 
bfure b 6olS per cent. In Tbiale'a ttatiilica of 
liver gunahot wounds in dvil practice the mortality 
in 100 collected caaea was 49 per cent. From thu 



low percentaoe, 19-4 per cent of deaths in Liek's 
6dd hospital, the c on c llio ii that liver injuries 
have a better prognoaia than other abdominal in- 
juriea, would be faue. As in other gunshots of the 
abdomen with intestinal injury, peritonitis domi- 
natca the field, so in liver injuries, hjrmorrhaca b 
the daofer. The majority of serious liver wounda 
succumb to hemorrhage on the battle field or in the 
field hospital. 

While hemorrhage is the principal danger, it b 
not the only one. Simultaneous injuries 01 adjoin- 
ing organa — the right Iting and the right kianey, 
capecially — may endanger life owing to necrosb, 
abaocaa of the liver, thromboab of the large blood- 
vcaada, and secondary hemorrhagea. These com- 
plications claim many victims. 

The treatment of liver shots may be summarixed 
as follows: Simple dear-through shots will recover 
with rest and morphine. Symptoms of heavy 
hemorrhage call for inspection of the wound and 
tamponade or suture of the liver as necewary. In 
tangential shots, especially those from artillery, the 
irregularly torn sinus must be exposed, bone spUntcrs 
of the riba and all necrodc tissue removed and the 
wound loosely tamponed. Complications in the 
pleura are to be treated according to rule. The 
after complications, such as liver sequestne and liver 
ahaceiaea, must be treated according to general sur- 
■knl principles. In the successful treatment of 
nver injuries as in other abdominal injuries, every- 
thing depends upon early treatment. Liek dtes 
several instances of the favorable results obtained 
from the immediate operative treatment of liver 
injuries. W. .\. Bmxxsas. 



J.F..andHe]rd.C.G.: Rdtaf of Chronic 
OteUmUia Jaundice by Palliative Operation. 
Am. J. M.Sc, IQ16, xlii, 174. 

The authors list the indications for operation in 
malicnant obatnictton to the biliary flow, as follows: 
(1) Sfistakea «M«g"**«^ — not infrequently opera- 
tion for aup poaet f m a H g n a nry reveab an inflam- 
matory conmtion whldi anbaidea with recovery of 
the patient. It b only upon such premises that 
the occasional "cures" can be reasonably explained. 
Moynihan says: "No one living b infallible in the 
differential diagnoab of obatractive j a u ndic e . The 
iWng*****^ b always so difkult and the chance of a 
life saved b so important that however positive the 
evidence of mattflnaacy may be I now ad\'isc opera- 
tion in all caacaT^ (a) The relief of distention pain 
— all caaea do not suffer from pruritus or the men- 
tal statea of cholcmia but suffer a gradual increasing 
Sin from distention of the biliary apparatus. 
) Intraaable pruritus, in many caaea ao 



that the patients iKMitivdy deaaand relief. (4) 
Social — to prolong life in comparative comfort ; 
to give the patient relief from his jaundice ao that 
he may live with his family- until tuch time aa death 
takca place from metastasu or local citcnaioB of the 
growtn. (5) Surreal euthanasia. The primary 
operative mortality in these conditiooa will be 
high, but considering the absolutely h o p e l e m out« 
look, together with the urgent demand for relief, one 
b warranted in sdecting an operative procedure 
entailing a high rate of mortality. 

A neoplasm at the ampulla of Vater dther by its 
preaenoe, by kinking of the duct, or assodated 
cedema of the mucous membrane of the duodenum 
or common duct will bring about not only biliary 
obstruction but a variable degree of pancreatic 
obstruction. The degree of obstruction to pan- 
creatic secretion will depend upon the individiuU 
anatonucal topography of the ducts of the pan- 
creas. In about 8j per cent the duct of Wtrsung 
carries the entire pancreatic secretion; in about 12 
per cent, however, the duct of Santorini is the main 
duct; while in 54 {ler cent the duct of Santorini may 
act as a substitute for the duct of Wirsung. In 
certain cases the duct of Santorini might remain un- 
involved for a considerable period of time, and, 
moreover, the duct of Santorini is not infrequently 
connected with the duct of Wirsung. and thus it u 
possible for a drainage of the pancreatic secretion 
to take place into the duodenum even with almost 
complete biliary stasb; in fact, there may be com- 
plete biliar>' stasb with little or no pancreatic re- 
tention. 

Any chronic obstructive condition of the duode- 
num below the ampulla of Vater will introduce 
in addition to the signs of biliary stasb those 
of pyloric stenosis, and in two of the cases pre> 
sented herewith the clinical picture was that of 
chronic pyloric stenosb and chronic obatmctive 
jaundice. 

In obstructive conditions at the ampulla of Vater 
it b usual to find the gall-bladder distended with 
bile (Courvoiaier). Thu b not necessarily always 
the case, aa a dbtinct hydropa and a wdl-dilated 
common duct filled with clear mucoid fluid has been 
observed, and when this rather uncommon condi- 
tion b seen it b aaaodatetl with pa t uloua cyatic and 
hepatic ducu and mechanically repreaeota a prca- 
sure scholia. Kausch thinks that the hydrops in 
these cases b due to exceaaive aecrction by the 
mucosa of the gall-bladder and dncta, whereby the 
duodenal opening bdng ocdnded the prcasurr in the 
biliary system bdng ao rabed that the bile secreted 
by the liverceOa b poured, not into the ocretonr 
ducts, but back into the blood and lymph vcaaatt 
of the liver. The most frequent obatractivc coo> 
ditioo ia from card noma of the pnncwna, a w pw B a, 
or dnodenum. Cancer of the duodemna wptm i a 
about 0.4 per cent of all cardnomata, and at leaat 
70 per cent of thb number are cardn o m a of the 
ampulla of Vater (Geiser). Pancreatic cancer 
is the most rapidly fatal of any form of carciooom; 



IHTERNATIONAL ABtlftACT OF SURGERY 



Mi witlria MVM or tlgk MoailM Iran ite 
if MMi of MCioMblt nfBplOBii Md o m m 
Ir bifora tlH fravtii MtiMUMiHi «r obiatei 
MQf fPHi Itcil MiMHtaL **TImv b pnhtkfy so 
pMltMi vkMa ikt bodjTt ovttidt tW CMinl Mr> 

vow QTMMI. «fc«« ASVWill, wUltyit to MMit b 

Mnldtd b)r HMfv wid^4pioM tyrMfMOBM ikMi ai 
ite tovw Md «f tkt rwni bit dad.** 

Am mamammk tarn bt aidt btivNH Uw call* 
bliiHir. or ibt bipalk duel or tbt cosMoo doct 
oad My uMUlgooM bowil Mifoet at (i) •• mmio* 
mattt of tki friModdtf ood vaiyiag portloM of 
ibti 



Um levtrity of ibr 



Itt 



J. llMiMMdiotoidliffromlicUM.iBadditiM 
to tbt iiiiJnMollM of lift, it M tw ipt t t MH y tuooc 



X 




HMiy; (t) I 

Md otrtoia portioM of Um viaoera, 
prvwHQT tbt iloiMcb or wMQtMMi or poftloo 
of tbt MoaR iMaiilM; or oMaiaaoaia btciMM tiM 
doct tad tbt aiooMcb, dMda— . or aaaH 
Tbt cboict of a partlcttlar optratioo will 
' of lactort todi as (i) the 
of tbt procodure; (a) the 
of Itrbaifil tfeonidUuMBli Cl) the rcUUve 
ty frooi aaoaMit^iofactiM; and (4) the 

tbt paticDi't 



lOBiy 



A coMidtraiiM of tbt Btriu of ( 

toay, cbo ltcy l M l a w a l Mg i . and cboMcyMooolot- 

tbat tbt btat ratoha an ob- 

Pbyiiologically 



taJMd «ilb tbt int pro ct d uio . Pb; 
BBMldirid tboo ia M o^ltctiM to tbt 
bBt ia tbt aioaocb. aa bit btM dtan 



oflM daicaly aad 



by Straadd b Ua os- 



pitiawaii M aaiMua. TwbairaWy, tbt oaiM of 
tbt 111 Waddrr aad tbt atoaMcb ia probably oMra 
omI^ parf i r id tbM aay otber form of aaaaioaw* 



ria. at tbt pina art aaiwiOy ia doat aad iatimato 
nimoadrip. Md litUt if aay MiNMaatina ia 



aaiytobriaftbtviiccraiaappoaitioa. Cbolaqratta- 
canita with U the poatlhilitira of aagnla- 
tba airrtiiiy for a aacoadaiy nttro* 
teprtvMt UaUaf, aad of ooant la- 
tbiwwiiicil gra aa d a tbt oaioa 
tbe coIm aad faD-bladdar ia to bt dap- 
aad pMoloticaBy it la dafactivo. lato 
tbt bOaqr atoiiiM lata a portfaa of tbo 
fBl tabt aoc givM to dlpailva prooaaaaa; aad opoa 
oibar groaadi it ia alM objactioaablt: (1) oa ac- 
ooaat of tbt idhm of tbt bkMjT cbai«ad bacterial 
OMttat^ of tbt obIm; aa d (*\J^*P«ilbility of 
fwenod auMtM canaaia aa daacobtd by Boodi 
(S> tbt fata of Ibt iRpilki ftractiBar of tbt bilt, 
o^wdiay ia tbt aapwiifHina of fau: (4) tbt (act 
ibat tbt bit ia aa aoM ovacaittd witb tbt atod 
MOM a nald Ioh of tbt add aaka of tba bik 
vbicb woald aetaMRy bt nabaorbtd ia tbt fatttailai. 
Tbt aatbon ca a d ad t la foRova: 
t. Att caaaa of obanaciivi Jiaadica an tatitlid 
la MMiiivt ooaddamtoa. Tbm ia a oartafai 
diAalit parcMUii of caaaa that ara cand btcaaat 
tbtri bit btM a ariaiaba fai tbt dtagaoda. 
f. Aiyof tbtabottoptratioMHtaolptabibitive 



4. OparatiM obvlataa tba dtvdopaMtt of ** praa- 
aait pala*' f ma iacnMb^ dbloaUM of Um MHaiy 
apparaioa. 

5. TbtM optratloaa an adviaed loldy aa pallia- 
tlvt p roca dan a. aad aa aadi tbdr purpow araat ba 
daiffly oadcraiood. C a Rita^ 



tt Rupturt of tbt Uvor (Rtpam d« Ida). 
FrtU0 mU , 1016. p. jso> 

Tbt caat rcporttd o ccam d in a wooua who waa 
kintd by M trp l n ai na caaatd by a bomb from m 
atropUat. After a few ndaotea tbt abowod all tbt 
aigat of a luemorrbafft, but then waa ao dfa of a 
woaad oa tbe thorax or abdomea aavt a nry aligbt 
redacaa of tbt lower Itft thorax. Palpatioa a b owo d 
a rib fracture. Tbt abdomen waa perfectly tande 
•ad not painful, aad the urine waa dear. The 
woman <Ucd in coma three-quarten of aa hour 
later without optralioa. 

Necropev ahowed a fracture of the dxtb left rib. 
Tbe left lobe o( the liver had a tear about a tafer- 
breadlh in width which involved all tbt pinacbyma. 
BMBorrbafe bad been free into tbt caHc i mJm 
and tbt pottttior part of Che a b doai ea . Tbt finr 
niptun may have mm dM directly to the fractur- 
ed rib dthouffh the pericardlam aad tbe diaobrafm 
were intact; or it nuy ban boM dM to a tboncic 
coataaioa from a atoaa or lump of aoR bailad by 
tbt wp l o ri on aad wUcb bad left no aurb m the 
iatogument. Nevertbeleaa, ibia liver laptan waa 
aot manifested phyaicaUy by aay aymplom which 
coald have auggwettd ita prMMc«. W. A. laavMAM. 

^D.t ladteailoaaiarGholacjMactaaqr. /. 

Aw^M. Aa., iQt6. Lrrfi, 6si. 

Tbt author Mbmllled a queftioaaaire to 4s o- 
pafiaaoad abdiadad aanaoaa* Tbt oaaalioM aa^ 



cyatoatomy ban bad a i i can Mc a of troablo follow- 

lag optntJM? Tbt aaaMrin 

Inr ap ana nritd from 1 to ssH 9^ ^"^ 

tat annit bdag 9.$ per ctat. CoRey reporu la- 

freouMt recamaoM. LaPlmglna3j>iiMro 

Judd writea, "Impoaaiblt to aial% bat wt ban 

a large auaabar of recamacaa.** Staatoa, who 

carafuOy bnaadgated Ocbaaar'a caaaa aad Ua 

rq»oita lacumarw of troabit fai t4.s ptr oai 

caaaa. Kdv aallBMlta than bM bna 15 ptr 

of fiflaraa ia bit voriL 

QaartiM a. An you p a t ftr ariag tbt opo n t i M of 
cb di c/at actony ama fnqatatly tbM ia ibt piti? 
Ta tbm than wm 4s aaawim 16 aMwwrad ia tbt 
afkiMdnb ate tba atgaiJn. Bovm 
pmfona caalacyilaciaaQr ia from 80 to 00 pti 
of tbair caaaa; Ddac tai 60 par oaat; GibbM ia 
d diffft ia ssH par 



ra 



la ia 90 
Mania 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



3« 



«iBploy» cbokcyttectony mora fitqamtly. but con- 
tklan It a mora <U f tf o m opg ra tion; Dcavcr, more 
tnqmMfy thaa formerly, bat not m often u m»ny 
snfMNH; Crile not mudi mora often. In 1907, the 
Ifavo't performed 100 cbolccyttectornkt, and »6i 
dMlecyttoMomie*; in 1915. 915 cbolecystectomiet, 
and but 60 cbolecystostomict. That wera p 
Mnthre repUct to tbe question. Bloodgooo, 
Kmy, Cnllen. «nd Grant are not perfonning tbe 
operatioo to frequently as formerly. 

Qoettioo j. Have the resaha been better than 
when simple drainafe waa need? To this 36 
a na i rai td jrcs; 7 answocd no; a failed to answer. 

QncatioQ 4. In what cases do yoa conrider diole- 
qrstectomy the operation of choice? The chief 
intfcations for remoyal of the gall-bladder recom- 
mended by the majority or any disease of the gall- 
bladder indl itsdf and damage to the cystic duct. 
Eighty per cent advised removal when any disease 
of the gall-bladder wall with or without stone is 
found. Several called attention to the possibility 
of systemic joint infection secondary to disease in 
the wall of the gall-bladder, as pointed out by Rose- 
now, and advised dmlecystcctomy as a prevention. 

Oncstioo $. What are the cont ra-indkations for 
c h olecy st ectomy? The chief replies wera inexperi- 
ence of the operator and ine^terienceof the anesthe- 
tist. In addition to thcee many specific contra- 
indications were urged, most noteworthy being 
chi on i c pancreatitis with gastric symptoms which 
cannot be cured by cholecystectomy but requires 
prolonged drainage. 

QocMion 6. As a rule do jrou treat acute empvema 
of the gall-bladder with cholecystectomy or drain- 
age? To this 44 men replied; 33 favored chole- 
cystostomy. 

Question 7. How does the mortality of cholecys- 
tectomy compare with cbolecystostomy in your 
work? Among the 44 answers to this question, two 
stated the difference in mortality was not known; 
4 men's wotk showed a lower mortality for chole- 
cystectomy than for cbolecystostomy; 18 reported 
the mortauty the same for each operation; and 21 
had a Ui^ber mortality for cholecystectomy than 
for cbolecystostomy, ranging from 0.5 to 3 per cent. 
The mortality for either operation was estimated 
by many men to be below a per cent. 

The author's conclusions ara as follows: 

I. Reporu show that recurrences happen in 95 
per cent of cases that have had cholecystostomies 
performed. The rec ur rence of trouble following 
ch ole cyst ectomy b certainly small; the exact per- 
centage b not known. 

3. Cholecystectomy b employed much more 
frequently than in the past and b a better ope ra tion, 
but it b attended witn many more operatiye diffi- 
collies and dangers than simple drainage. The 
giB-bladdiT shoold be lem oysd when iu wall U 
WMied or the patency of the cystic dua b in 
gmtioii, provided the patient's condition will 
permit it. 

The contra-imfications for the operati on are criti- 



cal states of the patient, acute empyema, infection 
of the dncu, and pancraatitb, where drainage b 
desired. It b safe» to treat acitte emp ye m a of the 
naimaddfr with simple drainafe, mm it b only 
fair to explain to the patient that a second operation 
may be necessary. C G. Hcyd. 

Bnlfour. D. C: The Spleen In Iu lUtetkinahlp to 
Pernicious Anmoyn, Splenic Anmmla, and 
llsMnolytlc Jaundlea. Cuud. J. M. tr S.. 1916, 

xl. 47- 

The author makes a series of observations based 
on the study of splenectomies performed in the Mayo 
clinic for varioos diseases. 

The splenic function b not fully known althou^ 
there is ample evidence to show that in infancy it 
is part of the blood-fwining mrrhanbm of the body. 
Removal of the spleen b not followed by metabooc 
disttirbances; thus differing from otlier ductless 
^ands. Its function in adiUt life b probably that 
of a scavenger of waste matter and b no doubt 
supplementary to some other organ. 

The q>leen b first cNndcnt in ue foetus about the 
fifth week and arises from the mesogastrium. At 
six months the triangular shape, caprale, and mal- 
pifhian vcssds can be easily differentiated; the Utter 
being formed by a collection of lymphocytes in the 
adventitia of the arteries. 

Splenic anrmia or Banti's disease b characterixed 
by nlenomegaly and a definite blood change. 
Whetner the splenomegaly b the cause of the blood 
change or Wee versa b unsettled althoo^ the im- 
provement following splenectomy would point to 
the former. 

In eaHy typical cases the diagnosb b simple. 
The low color-index, absence of nucleated red celb 
and enlarged spleen are pathognomonic and exdnde 
anemia of the pernidous typt. In the latter stages, 
characterized by cirrhotic liver, ascites, jannmce, 
and repeated turmorrhages, differentiation b dif&- 
ctilt. It u likewise most diffioilt in cl dl dra n to 
dbtinguish between von laksch's disease (sphnfe 
anemia of infancy) and the more adult type; the 
blood-picture of the former showing a leooocytosis, 
a variable number of marrow-cclb, but a relatively 
high color-index. 

Although splenectomy b the operation of choice, 
the presence of continooos high fever b c o ns id er ed 
a bad prognosis. The moctamy of the operation 
depends on the stage of the disease. In the Mayo 
clinic in 31 cases it has been 9.6 per cent. In a 
case occurring in a child of two and one-half jrears 
splenectomy was followed by complete leio y eif. 

Hnsmolytic jaundice b characterised by chronic 
jaundice, the result of hmm o kfwk and spleno- 
megaly. Etiologically the splsik factor b strongly 
suspected, as marked iaspfoViwifint foOowa sfdesMC- 
tomv, the r61e of the ipfesn probabhr bdnc similar 
to that of the thvroid In exophchalnac foilar. 

The congenital form of this diaaaaa is aMst com- 
mon and b nsoally lamiliaL It b dmractcfiaed by 
JaowSoe and splenooMfBly from birth. The ao- 



I 



INTKRNATIONAL ABSTItACT OF SURGKKY 



i|WfvQ lanM • noM coflUMs to iw iMiq qscsqc 

MM m WHWA MOfV WWit. U Mill* ' 

of iW Iftmdkv. mbiit, iMMbdw. 

itefBi A^r fouiHl TW JuHMMct dOM Mt CMM 

kcMBt. iImv arr M day tiooli or pilocM*, tad 
to tlw p«lM-fMt m to coawMM dact 
' h Ml >l^>^yt p w Mt to 

Urobflto it nMMtty fowid. 

onv i* ihr optnitoa of thakv ud k not 



CC1U \ < 

Alibottgli 



• oMftaliiy o( !«• iImb s pcr 
t <• * bogr opd otot it ciiod. 

W to MflrfdOM UMMrfft kM 



toMcko 
tMifilX 



of tttfiMot lu vatoe i«- 
Howrvtr, U it woctl^ of omh 



btM 



fwfawtofMood. TW 
licM to ilrit 



rcMiht to bo obUrfMd hiriplciicrtomy 



tROlarot. 



, J.: A 
t of • 

>X (Elot 



TW opera* 

or oac of 

by irtoo- 

of the pa- 

ivc of the 



atoto: " Chir rxprncooe 
aa to laad at to bciirve that with Cur- 
at to tW praprr ■ <!€€! ioo of catct. 
cmainty at to primary 
probably tale ff»uli». than aay form oif 
r M. CaAta. 

In the Trmf- 

I tHih Tbor- 

bri (for Toriuai X 

). Tr Xt X0Hk,Smtt. 

Cmc^ flt r i ab ii. *o*^ Joly- 

A caaa of Baalft tlittair vat trmicd with inkc- 
aa of iboftoiX. Akhowh »mallcr doaca liiaa 
vtro cMloyod waitran tliin ihtmw devd- 
aad the Banil tjiiloi ditappoaiod. 

L. A- JnonoL 

MBcnxAmoos 

(tapport tor bafe oMbOt daat la caviii abdom- 
iaalt). Pfum mii.. 1916. p. 15 j. 

BoTMby laporu low caaet: two b«llci« embedded 
to tW cpiplaoa, oao to iW airaoidalloop. and ooe to 
tW uaiHiiii aaaocotoa. tW latter & of aipodal 
iaiorait.aail araaapawiraiim iboracifo alwkwiitotl 
wohmL TW oriice of calry wat 00 the auxiUtry 
Mao at tW lavd of tW aevcatb rib. tW bullet 
rHMtotoffiot to iW oppar part of tW abdooriaal 
cavity abotM a iandMaadtk abovo tW^boid 
A BMdha aabaaibiiical iapaiotoaty 
hmI iW balel waa fbaad tftfot^nl to iW 
of I W ttaaavcnt BHancolna to tW rfabt of the 
voftobnl oetoanaad batbad to a aauu abacctt. 
TW aatbor caW patticalar attcatioo 10 iW foOow. 
iaf poiaia: 

t. TW total abaaaoa of aay (uoctioaalajraipcomt. 
aitbcr pIcarapaiMoaBry or abdoadaal, from the 
iW onaiiaaia of iW tojory ap to tW 



taaatjfHhfad dnr. CaMio-iatatiiaal ditiarbaaea, 
paia to t W ripbotd appaadioaal Nflioa« aad aaalava* 
tioa of loaMitafa wldcb caOMbr targical opara- 



r. TW trajactory of tMt prajacUla wat qaita 
ottraofdiaary. It iravortod tba fdaara. hmg. 
dtopbrafai. paawd to froai of tW bo(hr of tW paa- 
cfiat. btblnH ibt ttoaucb. aad pamlai tW baad of 
tW paacraaa. bariad itaetf to iW traatvaraa 
coloo without injurinc any of thcte orytaa. 

W. A. BanraAM. 



;D.i TiMRAIeofVI 
of Archrttia Def« 

iQia. siv. 511 



la iho Kcioloiy 
Am, J. Orlk. 5«rf.. 



part 



Arthritit defonaaaa (rbaaiaainid anhrilla,claaalc 
polyarthritlt) b a rinaaaa of coaarfas aiiokfy; 
many caaaca baiac active in its ia c ap t ioa, aad aiaU* 
larly after It baaoaoe begun, maay caataa pbndag a 
ia pcrpctuatiac it. That cartato todifMaak 
a laaaaaad Joiat f«aiilaaoa« aitbar bandhary 
or aoqairad, aeaaia a naocaaanr aaaaiapiioo. It (a 
alto evident that anythinn wbicb loaa it aervo>toae 
or allectt the quality* or quantity of tW blood aapply 
to tW Joinu acu Mill further to impair Joiat vitafity 
aad to prtditpoaea to tW devalopawat of ioiat 
diaeate. TW accamulating evideaoe poiatt to Maae 
focal infertioo ctpedally of a muooat BMadwaaa. 

He conclude* a* follow*: "It teeoM to have beta 
demoofttrated that the active agent in arthritt* 
dcforman* may enter ihroufh tW intettinal tract. 
Tbit active agent is u n doa b tad l y Wctrrial. probably 
ntoat commonly »treptoooccic and the intcttwal 
mucota b thut to be rcotrded at one of a number of 
mucout turf ace* throuipi which infection may enter 
tW tyttem. Through the production of ttaait 
aad probably alao through its influence on daadalar 
tecretloaa, v i ac er op t oa i a acta to caute to craa a e d 
totcttiaal iafectioo. and 10 favortmrateaiic to v a tioa; 
thut. in an individual with leateaad Jeiat laiiitaact . 
it may be the deciding factor in tW devalopaMat of 
artbruit. How frequent Iv arthritb da n al o tlt to 
viacerop t otic »ubiect». and what the prooortioa it 
betwo en the number of ca«e» of arthritit one to tbit 
caate and ihote ariting from other intettinal iafec^ 
tioat caaaot aoar W ttatod.*' Paoiy Lawn. 



). J. it m4i. 

of intettinal ob- 
cpiftttric pato 



Vltrac« J.: 
(Ilcmk 
4« BWr««jr.'i9i6. Imvfi, ito- 

TW autbor icportt a caaa coming to tW bo^iital 
with tintpianieaablf 13 
ttractioa. Biaadaatioi 

boib tpoauaaoat aad oa rtiriaaal piawara. TWra 
waa atoderata rthlallna of tW abdaaHa. TW 
thorax gave aoaM aaJlaiaral yptoaw. abotttioa 
of viaifwlar aMmaa iB» bat aaitaar vauliiac aor «• 
caaaiva aoaority. Tbcae «ai« aaofbcd to polaw* 
aary caagaaiioa. 

Lapaiotoanr did not taooacd to diadoatag tW 
true coaditloat aad tW pailaal dlad tWdayfeboa^ 
ing. Autopty aboaad a tout bandal apwlagia tW 



GENERAL SURGERY — SURGERY OF THE EXTREMITIES 



33 



left put of the dtaphnifm bchiiid the pcficardium 
and midway bet ween tne aortic and CBMphifeal 
opeaingt. The hernial ring nteasurcd s cm. A 
large part ol the large and small intestines and 
almost all the great epHiloon had herniated into the 
thonck cavity. The condition was apparently of 
long standing, the strangulation being due to a 
second loop oif small intestine becoming herniated. 
The author bdievcs that in a laparotomy for a 
I jM- ui intestinal obstruction where the origin is 
doubtful, ii it b seen that the obstacle is highly 
situated the possibility of a diaphragmatic hernia 
must never be overlooked. In order to discover 
this, if existing, the hand must be introduced under 
the cooca\'ity of the diaphragm after having 
travcfsed the greater curvature of the stomach. 
If such an exploration causes any doubt the opera- 
tion must be interrupted momentarily until a 
careful re-examination of the thorax is made and an 
exploratory puncture if nee<led. If the diagnosis 



then becomes evident, or if thus made in the course 
of the laparotomy, thoraco t omy should be done, the 
herniated viscerv freed, and the hernial orifice closed. 

W. A. BaexxAx. 

Scroam. S.: Evcntracloa mod Hamfai Dfaiphnit- 
ouiclCB from a Rosnf^noloalcal V I ew po tot 
Obcalnad from Several Gasas Dtegnooad wicli 
Cba X-Ray (Ueber Kventratio uad Hornia dia- 
phragmatica vom roeot geo oloK isc b c n Gcsichta- 
poaktc SOS snlsfsriirh 



tisierter Fadle). Tr. XI Nerth 5arf. Ctmg., 

borg. 1016. July. 

In the literature there are over 500 cases of hernia 
diaphragmatica reported but onlv a few were diag- 
nosed and operated upon, and these operations 
were for incarceration. The X-ray permits a much 
more certain diagnosis and result. The author 
by means of X-ray pictures demonstrated a series 
of such cases diagnosed in this manner. 

L. A. JtmxKE. 



SURGERY OF THE EXTREMITIES 



DISEASES OP THE BONES, JOINTS, MUSCLES, 

TENDONS. CONDITIONS COMMONLY 

POUND IN THE EXTREMITIES 



Barnr. J. 

Koani 



M.: Obaermtions 



th« Prsoeoce of 
Aaoodatad with 



RoaMt gaa olqtI ca l Shadows 
SaMsltold Buraltis: A1m> on the Prsocnc* of 
BhBflar Shadows In Other Parts of the Body. 
Am. J. Orth. Smrg., 1916. xiv, 482. 

The author believes that it is evident that in 
certain cases of clinically diagnosed, subdeltoid 
bursitis, the roentgen ray has shown shadows in 
the regioo of the subdeltoid bursa, which have been 
proved by operation to be due to a calcareous de- 
posit ; but it b in dispute as to just where the deposit 
occurs, i.e.. in the bursa, the walls of the bursa, or 
in the tendoQS and bodies of the spinati musdcs. 
In certain other cases, where the roentgenogram 
has shown shadows similar to the above, they nave 
been observed to disappear under simple treatment, 
to exist without cansug serious inconvenience, and 
to be present in at Inst two regions other than 
the subdeltoid, vix.. over the great trochanter of 
the femur and at the knee-joint. 

The shadows may appear very shortly after an 
injury, and have been observed to disappear almost 
as ouickly. They may be single or multiple, re- 
sembling ihc shadows of calculi but are sometimes so 
utCMiva aa to SMMt the extravasation of an 
opaove fluid in the Ssties. The operative findings 
mrald tend to show that the shadows are due to a 
calcareous deposit but it is difficult to believe that a 
cakareoos deposit could be laid down so rapidly and 
at times reabsorbed so quickly. 

Berry states that the whole subject b at present 



very confused, and that all cases should be carefully 
studied and checked up by roentgenograms, opera- 
tion when indicated, combined with careful anatom- 
ical study and chemical examination. 

Phiup Lcwix. 

Campbell, W. C: Localised Ostcospondylltls. J. 

Am. il. Ais., 1016, Ixvii. 572. 

Osteospondylitb b a new term, applied by Camp- 
bell to a local process affecting a single intervertebral 
disk. The condition b analogous to monarticular 
osteo-arthriti^. or to limited spondsditb deformans 
of the hypert rophic type. The X-ray shows crescent- 
shaped lamclljc of bone, thrown out from the body 
of one vertebra to its adjacent fellow, sometimes 
completely encapsulating the disk. These hooy 
lamellv may connect the bodies at their margins 
or may extend from the center of the exterior sur- 
face. 

Of the four cases cited by Campbell one man had 
been operated upon for appendicitb. and later for 
"adhesions," before the true etiology had been dis- 
covered. 

In the discussion of the paper it was brought out 
that the condition is not be be coostmed as any- 
thing but a more or less local manifestation of a 
generaUxed process, and that the term "infectioas 
arthritb of the spine" should be used iiMtead of 
any new term. Roaaar G. Paoubd. 

Prelbrrtt. A. If.: The Evolutioa of Oa t eoc b oadtiria 
Deformans Cos* JuveaiUa. J. Am U. An., 
tOtO. Uvit. 65S. 

The author reports two cases of Pwthe's disease 
and suggests that the disease b of sccoodary infec- 



14 



INTKRNATIONAL ABSTRACT OF SURGERY 



Mm iImi of tW adah dMHMMhrt iftlH 



■ftMdt 

ii dUhn ffooi k la iImi iImn b m mw boM for— 
bifort iW iitnat ol FntWIi 
te i«ie ««« noti Kkaly cdM alld 
labtRabriij aad npoitt of locavoiy villi fall aw- 
liaa of a tabmajir Mp piabablx «ffo baaod oa aa 



IlMaailHrtfHpNMwiiliUii. whohMi _ 
od a traaaMtk iUolaor, aad cfium thai a carrful 
o4 tW Mawy ini mvmI la aMit casta aa 
icay coadHloa vna lasBt low aad 
For uoauaoal ho 



loSf 



Um Uoa iImi 
adU aad maia of faacUoa pracUcaDir 
■ockaakal nroicctioa k aaacccnaiy. Be 
ibai OPililM-Mafing i* influmi Ul in I 
iW dflonahy a* *<rm in the irnniaal ttofn. 

W. A. CtAaa. 



an 



T.I CoatwiaMtioa co Um PailMioMriB of 

laiaoo (Coaifiboto aOo paib> 
dl 8dyatt«r^O«ood). PM- 
•«i«. nO, IM. cftir., IIS. 

TW aatlwr Rfafs to tW poal (Haaopaadot aoMag 
iko varioai aailMMS who mvo wriitai oa ibo palbo> 
■■Mib of Um ai^callod OHBodoSddatlv <nioasc. 
Bo wfm«acdactlyioibo¥ai b ai ll MO ifa i ad f a accd, 
aoi oalv by Qifood aad Sddaticr. bat ate by Ak- 
hmg, Mvaaaa, T b o Bip ao a , KlfduMr, Wimom, 
ScbakSt aad oilMra. 

A caoc la daKfflwd by Uw aulbor io wbkb a bov, 
la tbo aa of ikroaiat a atoac, fdi to tbe 




lOfojpala la the riffat knoe. 
walkboo 



boBM, aad waa ueat* 
m. Tbe paia and fuactioaal 
aad aboot a moeUi laior Um 
the aathoff'a care. Ft a ia i a a tfffa 
a laaMlKdoa deaily drcaaMcribed to the 
aatorior tabaarfiy of the llhia, palafal oa pfM a aie, 
adlhoai ocdgraMaia. and withoal the Icoet trace 
of OMeooa oepitatioo. Oa the boeia of thia 
kfk oBuaiMdoa aad the fafthar 



that It 



of< 

of the r a dh j n i p fci i» tUa 
at the level of the aaierior tibial taboraaity 
pofllally detached fram the 



i« the baflaeat 
hy fy lu I 



ovidmly aw aiB la oeailaalty ^ lu laparfor pole 
aith the tibial body. The oeaioar of thia fi^aieat 
«ae Intgalar aad It appeaiad to be ia procew of 
abaoquioa. 

The aathor. labordteatlat the faMevpiaiatloa of 
the nafiompa to the tif iyk flf data, thiaks that 
the boy Gi the thioaiat ef the atoae araii have 
laeeraicd the rotaloilbiBa teadoa at the poiat la 
which it la iaicfted la the tibia aad eapecUly the 
asderfyiac perieetoaaa vith teaiiM of the oMooaa 
laaMHs* aMdh coaetitaie the aaierior pftnlfta 
of thciabcfoeiiy. The poiat of 



la rariMaaot OHMod a partial (uao- 
tloaal lacapadty. 

Roviewlaf the varioaa palhopMMtlc iheotiea the 
aathor wlecti that of Scbulu. which b boeed oa 
the priadple that, f oOowlaic « bruMiae coatractloo 
of the foawral qaadrkapa. BoaM teariag of the perioa- 
leaai la pre da cad where the leadea of thia aaKle 
it laaefted ia the boae. To theae perioeiaal laoara- 
iloaa, which aceordiaf to Schalu rMalt from a pa- 
cral waeltni of the whele oi«aalBa^ there la aa 
•licratioa la the fwapectaeai of tbe aa deri yl^ 
boae which favon cither total or partial diipiaee- 
Bieat of theapophyabfoOowiaf aaaovoaMat of the 
limb io esteanoa oa the thigh. 

Tbe author thfaika that the itady of hi* caeo 
aho«» the truth o( Schttlta' theory: 

1. In the sharp cootractiooa of the quadrioapa 



of teadoo. 



a. Bf the p eri oeteal bwaratioaa, eMwdally at 
the tibial insertion with aoiac iajory of the boay 
laaidlc. 

3. Bv the incipient rarefactioa of the oneoaa 

tiwues following nutritive de6cieac y. 

4 From the general debility of tbe aabjact. 

He i» of the opiaioo, therefore, that Schaha' 

tioaa beet accord with the radiographic aad 

aad that, aaleaa deaMaauatod 



to the ooatrary, the Oigood-Schlatter diaeaee ouiat 
be placed in the group of. traamatic leiioaa, to 
trauma bring added a general debility ia the pa- 
tient. W. A. BanouM. 



Pratt Woaada of cbe 



Large 

aMli 



ikahntf of tiM Rboo aaalUp 

artlcalauoaa eo paiticaiiw gMoa 
«« mim. Ste, it St, df Far., igt( 






'). BoS. 
7, i«t6, xBi. 1777- 

Prat believca that when an aniculatioa injury 
ihows erideat iaioctioa it ia nerraeiry to opaiate 
aad to do eo widely. He iariau oa the laadbaa 
aatara of certaia arthriteat partiralarly thoae which 
malt Iroai the propaaatioa of a Aaaare r"""T'l'"g 
from a periarticiabr iraaare; there b at iiat ao 
paia, HMrely a p i ogr e eri ve lacreeee ia palae aad 
teaiperature. 

If the iafectioa la iBght Prat draiaa the artkala- 
tioa at the loweet poiat after arthrotoaiy aad ether 
lavage. If the iafectioa b aMre aerioaa aad a re- 
tura of awvaaMat caaaot be hoped for he aMkea aa 
extreaMly bu|e arthrotoaiy with which he oftca 
coiabiaee a ay aofa ct oa y, the Qraovial appeariag 
to him oae of the priadpal eleamau for the pmria- 
tcocc of tbe ■apparatioa. 

U arthrotoaiy with or withoal aj raove ct oay ia 
la e affirifnt aad there la aMch boae dA»ia to be 
dearad, a rearctloa ii caBod for. Ia all caam of 
artkabr larioaa Prat faaawWHam the Joiat la oae 
of Ma tgMTial appacalaa. Ia 6 caam of I nee Jolai 
l^larim where opetalioa waa carried oai iS to 14 
hoaa after o c c an eaca i l ac o eeto d with 
aad I wiUi aakyloaia. laiUpcaai 
beea oht aland twice by riaiple pleai 
tioa with coatiaaoai otteariaa aad ia t caae by 



GENERAL SURGERY — SURGERY OK THE EXTREMITIES 



3S 



curettage ot the bead of tkt femur. In the 4 other 
cmm, retcctioQ gave 3 recoveries and 1 derth. 

W. A. BUXXAM. 



Chnput: Pet lni UcM lnr Aha c iM CompUomat 8tty» 
pmttv* AfflkffMi of tho Knvc (Sur In abcn 
pcriankulairaa cwpliguain k» anhntu aup p ui l M 
du griMia). BtJL «i mim. S0C. 44 (Mir. it Pm., 1916, 
lUi. 1783. 

ClMptt thinks that rtlijmwii of periarticular ab- 
icni to gencraOy very dimcnlt and very often it is 
not fooogniicd up to the time when the abaocaa 
is OB the point of opening in the skin, and then it to 
generally too late and incision will not cure the p«- 
tient. 

He thinks it to poarible to make the dtofBorfa mach 
rjuiier by taking the following signs into ooaridem- 
lion: 

I. A c o nsfaWra ble trdema of the limb and of the 
foot to alwa)"! to be suspected when it occurs in the 
ioorse of a knee arthritis, and very freouently it 
indicatca a poiteiior periarticular abaceM of the limb. 

7. When pressure on the thigh or on the calf of 
t he kg provokes an abandant tosue of pus through 
the articulation inctoiooa, araally there is an ab- 
9CCM tome distance away. 

3. Every knee arthritto well drained which to ac- 
iompanied by an abundant flow of pus or by per- 
sistent fever to in general complicated by a distant 



In treatment oi such a h a cemes , success will be 
obtained only by early action and even prevention 
shoold be attempted by free drainage and complete 
removal of bony fragments. W. A. BauouM. 

MncDooald. W. M.: Contracturca of the Hand 
After Wounds of tta« Upper Umb. Brit. U. 
J., 1916. ii, x)9. 

Thto paper to principally a neurological sur\'ey of 
the vafioos contractures of the hand as the result 
of war injuries. Some of the peculiarities of these 
contractures are: (i) They imrdy occur in dvi- 
Kans, in ofBoers, and rarely in nftn -fitmm i Minn f fi 
officers, (a) They develop after sli^ and rardy 
after severe woonds. (3) The thumb to rarely 
affected. (4) They occur more commonly in men 
who come from certain districts and th^ are es- 
pecially prone to occur in certain hospitab where the 
atmosphere to suited to the culture of functional 
tfoabfas, yet they can not be dassed as poidy 
hysterical and do not often jridd to pqrchotherapy. 

BowwT B. Covntto. 

FRACTURES AJID DISLOCATIOHS 

La Breton, P.; Practore of the Odontoid Process of 
the Alls. 4M.y. OnA.5iirf., 1916, ix. $49. 

The case reported to worthy of note becanse of the 

ler of the injury, the absence of paral^c 

toms, the voluntary reduction by the patient 

own subluxation, and the gradual r ec o ve r y. 



The patient, a male it years of age, was driving a 
wagon, while sitting 00 the end of a barret The 
bami gave way, precipitating him forward. The 
honca, s ta r tled, ran to one side into a pole, and 
OQ0 hone, backing suddenly, sat with hto hannches 
on the riipu side of the neck and head of the patient. 
Ftaminarion revealed wrv neck without spasticity 
of the mutdes. The patient was in constant pain. 
There was no voluntary motion of the head; the 
cervical spine showed a crescentic curve to the 
left. A bony projection to the left of the 
median line, one and one-quarter inches bdow 
the ocdput, was evidently the spinoos pn>> 
cess of the axis, displaced. Thto point was tender 
to pressure. Above thto was a depression and 
beknr, down to the sixth cervical, was another de- 
pttision. The finger in the pharynx discovered no 
special irregularity. Roentgenograms through the 
mouth showed a distinct fraaure at the base of the 
odontoid process. A lateral view showed that the 
atlas was tipped forward, making the anterior 
line of the vertebral bodies irregular. .\n antero- 
posterior view of the neck showed a bend at the 
junction of the third and fourth cervical, suggesting 
a subluxation at that point. Head traction was 0} 
no benefit. The advice of consultants was that it 
was too dangerous to attempt reduction under 
anesthesia. One week after admission to the hos- 
pital, the patient placed his right hand at the bacJi 
of hto nedc and hto left on top of hto head and 
wrenched hto head straight with considerable force. 
He fdt something give and at once the steady pain 
ceased and he foun<l he could move his head much 
more freely. 

The next morning he was sitting up in bed smiling. 
A plaster collar was applied and be left the hoqiitaL 
Six months later he was doing very wdL 

Pnur LswDc 

Ladd. W. E.: Practureo of the Lower End of the 
Humerus. Bottom U. fr S. J., 1916, clzxv, ajo. 



Ladd reports the end-results of forty-five 
of fracture of the lower end of the humerus in which 
the records were complete and the skiagrams satis- 
factory. 

These fractures occurred with much greatfr 
frequency in the young than in adults. The caaca 
were grouped into fractures of the internal con dy le, 
fractures of the cxtenud oondjrle, and sopracondylar 
fractures. 

The best resulu were secured in the fractures of 
the internal condyle. Fractures of the external 
condyle reqttired operation for re p la c e m en t of the 
fragment more often than any other granp. The 
positi<Mi of acute flexion to most a p p Hc a b l t for all 
fractures of the lower end of the httaacraa. Eariy 
passive notion and massage are not coodndve 
to the best results. Fracture of the lower end of 
the humerus treated properiy should result in a 
periect arm in nine cases out of ten and a uacfnl 
arm in practically every case. Roaaar B. OoviBia. 



J6 



INTERNATIONAL AHSTRACT Of SIRCERY 



lUvMi. L. Ci A Wkmmla M«clMtf of PlMtliM Vp 
fh m, n m m to dM mUmi af Hm tttaiv-Mac 

i«i6. a. t}(^ 

IflMMd Ol tmippiat Mid bndltinB tttr trlMlt 

Ifaib Md dM« fai feaclWM of tiMr dbow. Riwit 
ialfodacM a tlMpIt atlkod of corrvri iv* iMiioo In 
1 11 Ml infaM. Bt takm two Mrips of adhwiy 
piMltr It I t.s ladMt. TIm &rM ttiip wlntaJiw 
tkf focoArm la f«ll ioioa. hy vminJUm tbt arai 
J«M bdov iIm udU. Mid ibe fbrcann Jitit above 
llw wfiM. ihm aol iMoHoffing with ibc drrulaikm. 
Tlw Mcoad Mrip b applitd to ih ' ' * ' < fore- 
Am aad hoAd. thm plAcad ovrr >alder 
Aad iaod to ll» bock. Romsii. in. k\ap 



f. J.t TiM TtaAlBMai of Hip rnctwm. 
y ir 5. J.. i«i6. dnv. 4jA. 

CoiioB calk AiicatioA to tht "wretdwd ramlu" 
Ia yp fractttfts. 99 par ccot (poniAl or total) pcr> 
OMArnt cripples rasahlAg ffon the pmcnt mcthodt 
of irratmrni 

Tlwrr arr two clasMs: (i) the trochanteric which 
OAlte cAiily with much caUus. and in which poaitioo 
c oaoerAa u» ntostly; ( >) tubcapitaJar. where poai t ioo 
AAd booy tiAioo. the latter often (ailina bccAUie of 
qraovlAl toid. arr the p ro b k oi a. In the fir»t claia 
AAjr owcbod obtaining aAAclAAt abduction tufficcs. 
Tbe tobcApiialar. if ImpACtod AAd kept m, OAite 
•lowly. If MMMcocd. Aoo-OAioQ AAd cfippUAf reaolt. 

For 6 ycAia Cocioo haa accurcd impACtJOB Ia 
aboot JO caaca by the oictbod of hamoier MApoctlooa 
After coTfictioA AAd plAatcr apicA. 

H. W. M a y aaoom , 



Moorv.G.A.: TW HoAod SplOA AAd Whoal GhAir la 
iha TiaatmaAt of Ptacnraaof cIm Nock of iho 
Pooaur. B0*t*m M. (r S. J., 1916. cluv, 44A. 

Tht anihor fepofta tevcataoA CAica of fracture of 
tke bip trcAlod by bmaaa of pliiter-of-pArtt spica 
fai fknoA aad AbdnctioA« tlma pcradttiAf old po- 
ikau ia tirkaai dAAfer of hypoatAtic pnaaaMwi ii, 
dacabiiai. etc. Aie to be foAiad, aa op|Mft«Bity to 
bt » AAd about io vhMl cbdit tkraoghoot the 
period of diiAbility. H. W. Msvoaan. 

S. B.t A Plea for GoaaanMlHi la CiM 
Ttraafiant of Gtaoad yiAtiai Aa Ikaai a llaoac* 
iaaalaikal Standpohit 
i«t6.iCj90> 



Am f 




A ffoeotfeoolocicAl cm erieace with 
of fractare, tbe AOthor offer* the 



I. Perfect ■ p pori t Jo a or iHmaieat b ao( 
Mry to obiaiA A food lailMBiril or foActiooal re- 
Milt, or both. 

a. WbcfA ioaw AAterlor, poenrlor.or lAtcral dt*- 
plAoeAMat oriau. aot to caoMd oaa^Mlf the diam 
our of tbt ibAfl of A fNldM-biariai loaf booe, a 
aoad faactioaAl iwait caa bt iiptcltd. bat A loafer 
vmm for aaita aMM bt aaiidpAtcd. 

J. Ia Folt't Aad CoOta' ffACt area, a proper align- 



nwni u( ihr axvu* iter vlMiii ui i nr i iiii;< < i> i ti^ '7~ 

lua. and tbe Ada of tbt abtft of ihr radi> 
mwe betwtta tbt Mooad and i* - ' 
akboagh tbt tada of tbe fragntri 
are AOt la doae appoattJoa. will imHMHH^ gi^r guwl 
aAAtowiral and (unctioAAl molia. 

4. lAcaac* where doubt eaialaaa to the probabO- 
ity of obtaioiAg a aood foACtioaAl result . the potieat 
ahodd be told of lae coAditioA AAd allowed to cbooae 
betwreo the two nietboda of prootdurt. 

5. Patienta abould bt l af o n at d of the poealbiUty 
of ooo'union reaoHJag fnwa coattiiutiooal coadltioaa 
or other unknown c atiae i. ahboagh the eada of tbt 
fracture are in Rood appod ti o o . 

6. Probably Icoa tMA teA per cent of doted ftac- 
turn require aa opta operaiioa for proper Ibtatloa 
of the fracmentf. 

7. I'nuniird fradurea. after tix to dgbt wotks, 
in which deficient callua fomwtion b appareat, 
ahould be treated cooatitutiooall)- if indlcatloaa 
therefor eaiat, and the pAtieni thould be lAfOuraatd 
to put aoeit weight upon tbe limb before optrAUoa 
b Adviatd. RoBKcr B. Corooa. 



OptTA- 

oTtibt 



LAtluop,W.: The SHdtat Graf I Aotf tbo 
Suture In Freah FrACtoraat Alfeat T 
Ann. Hmrg. Phila., 1916, Idv. 6S. 

The author reporta a aeriea of 14J catta of frac- 
turn of the femur, tibia and fibula, radiaa AAd uIaa. 
and iNitrlla. He operated on 41 of thcae caait aaJaa 
tbe Albee kangaroo auture, or the aHdiag graft. aAd 
reporta very favorable reaulla io all caaca. He 
givca a few of the caaca in detail aAd ahowa radio- 
graioa of a number of caaca before aod after 
tioa. He calb Attcatioo to the teAdeacy 
antofeuooa graft to livt aad grow io tht 
of pua. 

The author'* procedure in all freah fracturca b to 
take an X-ray on admiaaioo. etheriae the patieot. 
reduce the fracture, immobiliie. and then take tev- 
cral platca to tee that the podtkM b good. If, 
After five totendaya. the limb appeara to be io good 
podtioo aa abown by awAauremeot and fiaiBJiiA- 
tioo. it b AOt ioterfered with to far aa opemtbai b 
timttrrr* II, bowtvar, there b dcforadty, or 
oiwiMli^. he dota aol delay, but cuu dowa AAd 
wta either the ktAgATOO auture or didiog graft, aAd 
puta the limb up Ia pUater. He recommeada plat- 
ter of Parb aa the beat OMAAt of imawb M Mtk a. 

In summing up be aaya. tbAt froai Ma a^Mdaaot 
in several baadrod catta. oarlag tbt pott four ytan, 
AAd hAviaf and wiita. plaitt, aaii, aad Itier tbe 
Albre methods, that tAe latter afforda by far tbe 
be»t rr*uli». JA«aa O. Wauaca. 

SUROtRY OF TBI BOIfIS, JOUITB, ITC 



Taylor. R.T.t 

lot Short LaiA. ^■t./.OMA.Sarg. 19iA.dv.s9t. 
To shortcA a leg Taylor recoouaeods the foOowiog: 
Aa iAdabA 15 to ae cbl haM over the ctttrad 

suffaoe of tbe adddlt ihfad of tbt ftanir. Pkat bi- 



GENERAL SURGERY — SURGERY OF THE EXTREMITIES 



37 



of the QkMibial fuda b made length wbe. afid 
by iraotvefW MCtioB of it the fiber* of the vasttu 
rxtrrnua are freely eipoeed. which by blunt diaicc* 
tion ami retracton can be seoarated down to the 
booc which is readily (reed oy muscular attach- 
ment*. A special frooved director ahaped like a 
sickle, with the groove on the coocavitv to carry a 
Gigli saw, is pasted under and around the bone and 
the dceiied length of bone removed. An intra- 
roednllaxy bone- peg is inserted, and bone- pegs 
throogh and through are used as dowels after the 
bone ends have been mortised with the upper frag- 
ment posterior. The dowels are made from a tibial 
graft. 

To lengthen a femur is a more diffictdt procedure. 
It should be a two^tage operation. At first the 
adductors, iliotibial band, and hamstrings are 
divided and the dowels are made from the tibial 
crest and kept in sterile salt solution on ice. At 
the second sitting, the technique described above is 
e m ployed. Then with the circular electric saw a 
linear indrion is made in the lung axis of the bone 
on the outer side of the desirr<l length, i.e.. at least 
3 cm. longer than it is dcstr(*d to lengthen the limb. 
With a thin roundeii or guarded end hand-saw a 
half section is made on the anterior as|>ect of the 
bone down to the upper end of the longitudinal in- 
cision. Similarly a half section i.s made on the {)os- 
terior aspect of the bone up to the longitudinal 
incision at the lower end. Next a nickel-plated 
spatula b passed around the bone on the inner side 
to protect the vessels, while a small electric drill 
cuts the cortex at intervab through on the inner 
side of the bone by passing it from the outside 
longitudinal indsion through the medullary cavity 
to the cortex behind. With a series of these holes, 
it is then ea^ with a small thin osteotome, to cause 
separation of the two halves of the mortise. Prior 
to the operation, traction apparatus is applied below 
the knee and is used until the desired lengthening 
has been obtained, when dowels are inserted in 
drill holes to hold the fragments in apposition. A 
long spica cast b then applieil. Philip Lewix. 

CoUle, J.: ImmobUlcyAlter Joint Injury. Laiuri, 
Loud., 1916, cxd, 338. 

Fixation for long periods of time after fractures 
or dislocations b umoit sure to result in adhesions 
forming in and abont the immobiliied joints. Thb 
should be prevented by early passive movements. 
Adhesions sometimes take place in as short a time 
as three weeks. They may bind together the articu- 
lar surfaces and the folds of synovial membrane in 
the joint, or they may be entirely outside the joint. 
The tendons may become adherent to their sheaths 
as a result of tenosynovitis, .\ttempts to break 
down the adhesions under nitrous oxide anesthesia 
in the out-patient department of a hoqiital b en- 
tirely wrong. The anesthesia u not sufficient to 
completdy relax the muscles about the joint and 
the patient docs not return on the succcedinf days 
for massage and passive movements which are so 



necessary. The limb should never be bandaged or 
splinted after breaking up the adheeioos. The 
musdes should be given light work at fust. In order 
to coax them, as it were, cradually iiifffiaili^ the 
wdghi or the work as they become strainer. 

Roaear B. Comtn. 

Iloraley. J. S.: Operative Traatmeot for Threat' 
•nad Gangrene of the Foot. J Am U Au 

igi6. Uvii, 4QJ. 

The causes of gangrene are discussed, namdy, 
arteriosderosb, intermittent dandication, Ray- 
naud's disease, obliterating endarteritis. In the 
author's opinion, in the reversal of the drcuUtion 
by lateral anaiitumosis of the femoral artery and 
vdn. the blood never reaches the foot. The valves 
in the femoral vdn cause an obstruction, and the 
collateral drculation takes up the increase. In 
reported cases where the procetlure has shown some 
improvement the result was due to increase in the 
arterial blood in the foot. Ligature of the femoral 
vein produces the same condition. Two cases are 
reported. It is doubtful if the results vindicate 
the operation. Cijstis Lex Haix. 

Borchgrrrink. C. : Wire Extenekm (Drahtextenstoa). 
Tr XI .\orlk. Sitrg. C»mg., Cfoeteborx. igi6. July. 

In cases of fracture of the lower extremity the 
author recommends the application of extension by 
means of an aluminum-bronze wire brought directly 
through the calcaneus. The method is also appli- 
cable to the dbow. 

BoBEUiTS acknowledged the correct prindple of 
the Steinmann extension method which b applifd 
directly to the tx>ne, but instead of the wire be ap- 
plies daw-like spring hooks to the booc to avoid 
the canal formed by driving a nail through the bone. 

L. \. JcaxKK. 

Blanchard. W.: Oaicotomy and Oateodaaia. /. 

Am. M. Aft., 1916. Uvii, 504. 

Several cases of severe rachitic deformities are 
reported which were corrected by the use of the 
Grattan osteoclast, which the author daina 
better restUts than esteotomy in childrai 
twdve. 

By means of the osteoclast, osteokampab. or bone 
stretching without breaking can be obtained, which 
has decide<l advantages. 

The arguments advanced against osteotomy are 
mostly theoretical. Non-union can be guarded 
against by avoiding operating in the subacute stage 
of rachitb. and avoiding c{Hphyscal trauma. For 
low anterior bent tibias osteoton y b pnlerable. 
The MacEwen osteotomy b adviaed in chfldiiiu 
over twdve or in adults. Ci;sns Las Hall. 



Rjrcraoa. E. W.: Pat Embottam In 

InckleacvandPmrvntian. 7 .!■§ If. .In.. 1916, 
Ixvii. 657, 

The incubation period in fat embolism b from 
twenty-four to thbty-siz houn after traumatism. 



INTERNATIONAL ABSTRACT OF SVRGF.RY 



whrtlMr Migkal or accUMlaL 




itiitt iMtft. Tktt tcmptrtlvrt la tUi varitty 
bMlpMllytlfvaitdbut Um palH aid iwplnuioa 
•fv rapid. WImi tlw fat paitti Iroai tbt lai^l to tbt 
Ml kmn aad iaio Um poiral drralatioa U Uuor* 
tnm villi tlw canbral drcalalloa, caiiiii^ aaaiia 
aad voodilag. loauMlMrt or ■ eomaiow ooadHioo 
9ma fDMir. TW t«apmiurr In tht» lypt auiy rlM 
■• Hfli a* 106 or 107* F. Fai appcafs la the urine 
aad momUmm ia ibr fpotwa. PnacWa in the 
•kia aMy appear. 

PmplqrUune b iW only taikfactory oMamia la 
imilat tide roadlifcia, TW imploymMi of ihe 
idkvaiqaet for iwilMW boar aflar a itvcta craihlag 
m«ry or dariac aa op erall oa k of gnat value. 
Amumt pracaaliMi it lo avoid ibe traaiportatloo of 
patlcai* with tadi lajarice. Roassr B. Consta. 




tkMiof tlM Hi 

RaiMMfBilMi QimiMiheilea dM deas-tian de 
IIhmmmim dm danla lialaflration aMoMiirae). 
Lym •«<., i9i«. cssv. 537. 

Novf -JoMcraad dice llde caee to show what pree- 
trvatioo of ibe pftioiliOTi caa do in war wounds. 
A soldier reccitrod a nmlM wound in the upper 
of iW thoabkr la Aagait, iqu. causinf a 
tlM appcr two-ihirds 01 the 
oHowad. Ob Sepleiabcr t, 
tW teaeral koad oral maovad aa veil at tbe fiaater 

Sof Uw d iap i g p ri e In the two appar ikinh. Sobm 
frifaiiiHi awe Idt which wtia aol wiond 
ihe faOowiaf May. In Tune. 1015. raifiof- 
rapliy ihowed thiat oahr the lower third of ihe 
rcmaiaad, bvi ihere were aeof orm otMoot 
aa of ptriftwif origia al the tile of the old 
phyria. Oaeof them. 7to8cai.loaf,wMjoiBed 
to the iafcriar frafmeat. Ia tha wperior pan 
aaother of the oaaw Ic^nh rrtaadad at far at the 
By Sfptea i her , 191s. the fuacUoai of the 
■era partly iw fatihitihad There was no 
■Harfi By May, 1916, with the 
at reM then vat a d lat i t il t of ahoot * col 
la activity iMt dlatlttli djtappatiad aad the ihoal- 
d« becaaM aold. Aciha abdactJoa BMivaaMBU ap 
to ^^ caa ba nada. fladoa ia f roat it Boiled but 
leoMi backward it vaqrftod. BIbow a wva ai e a t b 
empi that fittMlBa b Badtad to 4S*. 
W. A. 




Aay doabi aaqr 
at to the ivtatatl deialla 
hMatgrafla. 



T.I 



tkeiafara be dba^aidad 
toHdBiauloa of 
W.A. 



(Effahfui«M whar die Anhfo. 
abeHk bii i m wi i Aakjrloee). IV. XI. Mmik. 
Smfg. CSm«.. Geelahecg. 1916, July. 

To laBeva aakyloib or to prevant it the author 
ffw ti ll fatltctad vattfiat iato the Joint after the 
MMMiBbtaBa wattakaacaiaof. Thb BMlhod, 
howavar.caa baa ay b y ad oaly where the joiat cap- 
tab b iatact aad caa ha aavad. Flapt of fatda, 
at w npif ii i by Marphy la 1894, prevaat boey 
aakyiorit. Tha author tried the OMthod oa three 
kn ot Jo i a ti; the ratuk wat bad ia ooe cata. It waa 
M i cca tt ful , however, in two caaet of elbow-jouit 
aalnrloab foOowlag fraaore aad ia one Up ankylo- 
•b loUowiac a tepUc arthritb a year afo. 

la the dl t cut ti on BiaoaiAM atatad that in the 
lower aitraadtiit the ttatic laqaiiaaMau are tha 
BMMt iaqMruM aad ooa ooflit to ha tttbitd to 
conact a faulty poaitioB. In the upper aitraadliat, 
however, the joinu mav be mobiliaad la cprtaia ia- 
itancea. If the ahouidcr b bvolved, a pttado- 
anhraab at the davick b perhapt the awtt tatlt- 
(actory. Bcffmaa hat nobObed five Jofatta. Tha 
result waa food in a couple of hand caaet but what 
waa gained in nMbility waa loat in strength. It b 
very important to follow Up the operaUoo with 
diathermy. 

Haclumd Mated that the knee-joint shoohi never 
be m ob iHse d. The ankyloab, as a rub. baglas with 
iha pateUa and an attempt may be ande to 
Bwbinae it. He, however, has had poor vetalu 
with It. L. A. Ji 



lleodcraoa. M. S.: ThuMphuicatioa of Booe la 
Fracturea. J.-Ltmcti, 1916, uivi, 540 

The author reviews the literature of transplaata- 
tion of booe aad of foreign material as ouiBaad by 
various authors, aad hbcoodutioa b that if booa b 
tr an tpla at ad, it ahould ba from the saaie iadi- 
viduaL la thb ankk the author deab pdadpaBy 
with the use of boaa-grafu for old uauaJtad frar- 
turst. The ute of the iaiay-graft rather thaa tha 
latraaMduUary graft hat bcea hb awde of p ra ca d ai a 
iathegreataitnpabarofcatct. Soawdetaflbgivaa 
as to tha wttbnd aad rite of pfocurii^ the graft; 
aba the afta Mia a fil with mechaakal ' 

CCQiAi 



ctftflaibsaBedBlaatdsTiBakd. BmIL h mim. Sst. MXMrfeal 
drcMr.dr^v..t9t«,aa.its6. imkmL 



8.L.t TtaaspteacaHaa af dM 
of Booe lartiidli^ dM Bptptap 
Use. 5art., Gymtc. 9rOht,, 1916, isitt. jot 

la tha piateaft aidda Haat detdfbta tha 



The eiandaaiina of a facial graft from which 
lectieaa w ere cut after ttvaa itoatka ibovad that 
it waa ia tha prooan of 





that takaolact 
A lidtf 



ia a . 

ouiBae aad Hbritlna of tlw Blaratars 
tha artlda. Tha paper b bated apoa the 
obtaiaad ia 71 atveriaMda ptrftraied apoa the 
aMaMtatafBalboMtofdoBk lataoM 



GENERAL SURGERY ~ SURGERY OK THE EXTREMITIES 



S9 



ol the rxprrimcots the epiplmail caitilafc line only 
b tnintpiantetl. while in other* the acoooipftBying 
•nicular end or the entire bone is utflfand. 

In gcoerml he 6ndi that the epiphyseal cartiUfe 
line ceases to functionate in all cases after both reim- 
plantation and atttotraasplantatioQ, there \»tk^ a 
failure u( further looffitttdiiial growth. Mkrosoop- 
tcally there occurs a propasrive ifatsnernJun with 
substiiutioo bv fibrous tisme and finally a oomplete 
— " -• ol f" ' * • 



.. the epiphysoU cartilage line takes 

plaoa. The epiphyseal cartilage line is the least 
transplantable of an^ of the components of bone. 

The articular cartilage undergoea practically ik> 
changes after reimplantation, while in autotrans- 
plantatioo there is evidence of both degeneretion 
and regeneration. The artictUar cartilage offers the 
greatest possibility for successful transplantatioD 
of the various components of bone. 

The marrow undergoes an early necrosis, alter 
which there occurs a fibrous connective tissue change 
and finally regeneration of some of the marrow 
elements. 

The trabecuhe show early evidence of degenera- 
tion, as noted in the loss of nuclear staining. Then 
there is noticed a layer of osteoblasts about the pe- 
riphery, which later proliferate and gradually re-form 
the trabeodjt. 

The cortex shows an early degeneration, after 
which there takes place a new formation of osseous 
ti<t!>uc from both the periosteum and endostetim and 
a Unutcd amount from about the haversian caiuls. 

The least dependent the part of bone is upon its 
blood supply, the grnter is the possibility of a 
successful transplantation, as is the articular carti- 
lage; while on the other hand the more depeiKient 
the part is upon its vascular connections the less 
likely is the possibility of a successful tranqilanta- 
tion. as b the epiphyseal cartilage line. 

Haas concludes that, in spite of the fact that 
each part of transplanted bone can regenerate 
indepoKkntly and without any aid from the host, 
some additional factor either in the form of a chem- 
ical or a phjrriological stimulus or even some definite 
osseous elements from the host are essential for the 
continued life of the transplant. .Mihuugh fum- 
tioo may play a part in the process, it is not of 
prime importance. 



v.: Weight -Bearing Amputation 
.Stumps (Ucber tragfscfaife Ampuutioostuempfe). 
Tf. XI Sortk Smrg. CWf., Goetcborg. 1916, July. 

As shown by Ilirsch, amputation stumps can be 
made weight -iMraring by means of baths, 



an<l stepping esercbea. The author enploved 
Hirsch's principle in ten cases of leg amputation, 
but simplined the method. He p er f orme d a 
simple amputation with a laige posterior miacuk>- 
cutaneous flap and division of the periosteum and 
bone St the same level; suture in two layers; and 
a small drain from the corners of the wound, re- 
moved on the fourth day. On the tenth to twelfth 
day stepping excfdses are begun, firM in bed. later 



with the patient liltlnc down. The "-H— "tini 
iMi nl oni are soon ow ercom e . In the tUrd to the 
■u week a provisional prothcab made of wood and 
pfaller of Tans is applied, and after the second or 
thiid month the final one. .Ml ten patlenit are 
now walking directly upon the stump. 

L. A. JomncB. 

ORTHOPEDICS IN GBlfBKAL 

Taylor, H. L.: The Scandardisatloa of riff wftt f ffwe 
Affecting Posture. Am. J. Ortk. Smtg., 1916. tiv. 
569 

The author's report b based 00 the work of the 
American Posture League during the past three 
jrears. He describes in detail the pruidpies of 
correct seating. After much study and esperimen* 
tation a model was oflkially approved by the Leane, 
and scau of thb type are now in use on the Brooklyn 
subway. \ standard school chair was remodeled 
by the furniture committee to conform to hygienic 
standards auid has proved very satisfactory in actual 
use. Kindergarten and vocational chairs have been 
designed and tested. Work b now under way on 
office chairs and will soon be started 00 industrial 
and auditorium seating. 

It was found that boys ready-made ooau wen 
being made over round-backed roodeb and warn 
therefore too loose at the back aiKl too tight across 
the chest, pulling the shoulders forward and vir- 
tually compelling a round-back posture. The mat- 
ter was taken up with a large manufacturer and 
coats were remodeled to a correct derign. Shoes 
of three types — inflared, straight, and outflarcd — 
have been made and tested and will soon be on the 
market. Puiv UwtN. 

Boguc, E. A.: A Prosthetic Applianc* to Replace a 
Nec r osed Shoulder- Joint. Am. J. Smtg., 1916, 
XXX, >66. 

An apparatus to replace a necrosed fhrnMtr ^ 
joint was made of vulcanised rubber mounted wkk 
platinum, attached by screws to the shaft of the 
humerus and the scapula, the head of the device 
having the movements of a bail and socket joint. 
The apparatiM was enclosed in periosteum, and bone 
proliferation took place around it. The patient b 
said to have been able to use the arm almost 
normally. H. W. WnoMc. 

Parker. C. A.: A Plea for the Prrvrntloo of 0»> 
formilioi in the llealina of Bum*. J Am. U. 
.ill., igio. livii. 50$ 



In the treatment of burns of the third 
bums destrojriog the skin but leaving the deeper 
stmcturcs intact, Parker aims to prevent de f on mt y 
by fixation of the joint ditring the proccm of iMaJiaf 
and for sometime thereafter, to prevent 
quent cootraaurc. The dbow. wrbt, 
hip, knee, and toea should be kept extended, tWi 
should be abducted, and the foot should be at riglu 



INTERNATION.%!. ABSTRACT OF srRGKRY 



teSiui 



Tlir wr of 

Fo r tW infkm mk q| t W tww ka tM Jh akm ip - 

to tW VMM. e at x Mag mmm dbunct btywid im 
■HlM «f tkt bwn for •itadMMM !• mtimI akia. 
TUi b doM allOT dl aloiitlM iMvt Mpsraitd, aad iIm 
it dMMMl two or llmt tioM* a wwk. Thit 



i»r tm tU*^ aiir* «lMdl »«UUof M >MuWOd «llll • 

Irai tuailigi ovor Um kaw to pnywi iJMini, 



t dNMbit piwwtt «nA«aM eriyiiilnM. 
iW aBMUM of Mcmioa bjr mMmmo oo 
■ad cooMTvw Um h«t aad aoitlafo. A 



r it plaeod ovtr iW adMve aad 
it to br dMSfiddiijr. TImiv b ao poia oa maoval 
of the • Il iiri M rfa r i tWriac oridt wr v w yga brttcf 
ikaa tW popalar ** wi dNHlaB.** 

koout G. Paceaso. 

G.I T«o€3M«ofOMBVo^ (Z^dFaclk 

wo Con v«%i). Tr. Xt StflE Smtt. CMf.. 
Cwltburg. 1016. J«rfy. 

la botli caac* reported thcrv was an ipiplyml 
Mwro Iqr ibt X^rajr pktore — oat caw 
tlie otMT aoBalcraf. Tbc traumeni 
ia wpnriltoa, tad ippHcuioa of a plaater 
ia tWcorrodod inrrtfta 
BMOunn iM j c—b J tie bfalogfaJ rig ri j ra a ra of 
■a valvi. la hb opiaioa the aock aagle b Bot 
ipMdcat upoa the atatfc wciglM*lMoriag, bvt b 
dRcradacd in iotnMticrioc Uf e by tbe miMcalar 



Vara il'tbet Outotoam.'iart^ bci Com 
vMa). Tr. XI. .\0rtM. Smrg C0mi .lioeitbott, >«*6t 

Tkt avtbor daaioartratid caaaa of oMooloanr in 
vara. p« iraraa, aad pet valgoa, in wliidi 
nanlia ware obtained. 
Gtc«i«aK mmtioaed a caae of ooia vara wUcb 
«a» trr^icd with trfMHoanv and cMicotoaqr aritb food 

L. A. Ji 



tLi DIaabMtloa of tb* Ka— Jotoi. Bfii. 
y. J.. i«i*. B. iftQ. 

Tbe aatbor Haariira the iajorfca to the knee and 
oatlara tioaUMai for the varioaa baiom. 

For apnda of the iateraal tetoral Ugammi. db- 
liagidakH bjr pdm aad irodcracai vnK the iaaide 
of the kacc mftMkf at the attachMaau of the 
SfUMBl, he alfa^ the knrr firmly aad rabea 
thtfancraideof theahor hrd in order 10 dhrcrt the 
bo4jr weight to the aoi«tdr and rdieve icaaioa oa the 
iaaor aide of tbr knrr 

The iaaer aaadboMT cuiHofB b doiihr < 
with tiM faMoraoi lotofal IfHaaat aad ia 
twiau the cartfltii aMjr ht nrfbd loaM> with I 
of tiM hgaaMBl. DiapMme poini» tn: 
aHh MdTp^ oa the fanrr tidr of the 

Ulyatapoint juM iaaide tiM palel* 
the border of the tibia. 

The kaec ahoald bt tateaded oa apoaterior tplini 



the kaot to . 
Aflor each a mttJIaaa laaioa tiMre b 
a* mi oar t h of ciottfidal tiaaae aateriorly which aMy 
bacoait piadMd ia the joint aad miraaaiiatt opara- 
tioa for 11* reoMvval. 

A coa^pleteiy diapiared carttl^a, iadicatod by 
lockiaf of the Joiat. may be ndaead by placfaif the 
patieai oa hb back, the tidgh fleaad on tbe body 
and tbe knee iaaod oa the thigh, then, while the 

^1081 volttntarfty and forcibly csteada the leg or 
ka, the Minroo pulU on the foot aad rotatoa it 
Inward. The Irf i» then hdd in iitiaaioa for lea 
day* after which the patient walka with a fbrm 
bandage 00 the kncr. if the raftfltar continuea to 
|ivc trouble it fthould be removod. With ibc knot 
ieaad over the edge of tbe oparatiag table, iraaa- 
vtne iadaioo b made over the aatonor rod of tbe 
raitilija for eiMugh forward to avoid ihr lateral 
"g"— ■* No fringe of ranilage moat hr Irft aa it 
wfil canae continuation of the aymptoma. The 
author baa treated over 2.000 of thcae OMea. The 
afler>trratment ronaiatt in inuaofafliaalioa la «• 



then 



aad gradual 



tenaion for irn days, 
bending art begun. 

Rupturr of the cmdal Ugameata mav occur with 
fracture of tbe uiine of the tibia. If the tibia can- 
not br diaplacea forward whilr r 11 ended one may 
be aaaurcd that the anterior ligament b not com- 
pletdy torn, aad if it cannot t>e diaplaced backward 
while flexed tbe poaterior ligament b presumably 
not ruptured. ADaormal mobility in iheae dirrc- 
tiooa indicates an ckmgatioo or rupture of the cor> 
responding ligament. It b uaeleaa to attempt to 
aature the li^nenta. The kaee ahoald be fused ia 
a caat or apUat loag eaoagh to pcradt the foraMtioa 
of a healing dcairU. 

Fracture of the ^ne of tbe tibia b indicated bv a 
rigid obatmctioa prevcadag fall otcarioa, bat 
ahottid be verified Inr roaatfea raar cnadaatioa. 
If the fraflacat caa oe manipwiatod back betweea 
the c oa dy ba hy fidly eiteadiag the kaee, oMaipala- 
tioa with iiadoa b aU that b nanawity, bat & the 
kaaecaaaot befaHycitfladedthefrafiMalaiBaat be 
removed by op e r a tioa. 

Swelling of the retropatellar fat pad auv follow 
any knee injury aad give riae to qrniptoiaa by baiac 
caught in tbe Joiat oa fall otaaMoa. Ia aan 
caaaa a cork under t he heal or a braoa, aithar if wirich 
wOl jHavaai full cxtearfoa, ahoald ha wara aalll the 
awdfiag diaapprara W. A. Cuaa. 

Ci Ortbapadic Ohaartatiaa la dwTVaat- 
ol Atirfae raHaaayaiih. d»dl Ft4i*t . 
1916, twiii, j9o> 

The author NDorta oa a attidv of aboat threa 
hundred caaaa of lafaatHa potatyab 



during the apidaaric of 1907, tfiatad at the Hoapital 
for Raptarad aad Oripplad. aad the l ub aaqja a a t 

.Among the Iniereating poinu noted are the foBow- 
ing: 



GENERAL SURGERY — SURGERY OF THE SPINAL COLUMN AND CORD 41 



I. Twenty>five nuictits made a complete recov- 
ery, and are daaacd aa abortive. 

a. The diMMt wachwi its height during August. 

J. The aft faddcnce ol the attack was greatest 
between one and two ynn. 

4. Permanent paralyvb ol tome muadet of the 
lower extremity occurred in S4 per cent. 

Almoat all patients who survive an acute attack 
pratent mechanical problems almost from the begin- 



"^ 



orthopedic treatment of the acute stage 
be directed toward the relief of pain and the 
pfcvention of the naiaate of nerve impulses to 
the affected nerve<dlt, aad tUa b accomplished by 
rest and immobilisation in plaster-of-Paris dreaaings. 

In the stage of paralyab, rest in bed for two or 
three moaths with alcohol rubs and hot foment a- 
tiooa or baths b recommende<t. All attempts at 
movement, capcdally sitting up, are restricted, and 
any tendocy to contractures from overuse of 
minde groups should be combated. 

During the period of convalescence, that b, after 
the patient bejgiiu to walk, mttscle balance should 
be secured and maintained and the paralyzed 
muscles stimulated by massage, manipulation, and 
stretching. 

Braces have a large place in the treatment during 
thb period as they favor functional use. Conser- 
vative treatment along these lines will obviate 
the necessity of operative correction of deformities 
later on in life in a large percentage of cases. 

H. W. Wiixrox. 

Aahley. D. D.: Shoes. Physiological and Therapeu- 
tic. .V. y. M. J., igi6, dv. J41. 

Thb b a valuable contribution to the toopoorly 
understood subject of correct footwear. The au- 
thor considers first the requirements of a shoe for 
a normal foot, and paints out the common faults 
found in ordinary trade shoes. 

He next cooaiders the therapeutic shoe, modified 
to meet the ejmiptoms of mecnanical strain, weak- 
ness, and dis«ue. Espcdal stress b laid upon the 
faa that many disabihtic* of the foot arc traceable 
to the faulty construction of the heel of the shoe and 



to a too rigid bed aeat. The bed b commonly too 
high with a slope forward so that the from of the 
foot b crowded into the toe of the shoe, thus favoring 
hallux valgus, hammer toe. corns, and buniona. He 
advocates the selection of a good trade shoe hmmB- 
fied as needed in preference to a custom made ahoe. 
Children's shoes which approach the physiological 
outline are readily obtained, the manufacture of 
men's shoes of the right fthafie b increasing, but 
women's shoes of ihr prufier lyfic are difiicidt toot>- 
tain. H. W. Wiirox. 

Lovett. R. W. : A Plan of TrantaMat In Infantile 
Pamlysis. J Am M .in.. 1916. Uvii. 4^1 

Lovett reviews the prime cssentiab in the treat- 
ment by dividing the course of the disease into three 
stages: (i) the acute or stage of onset, {3) the phaae 
of convalescence, and (j) the stationary stage. 

Under the Anit stage the im|M>rtant points are 
absolute rest until the muscle tenderness nas disap- 
peared, and the prevention of deformities by proper 
supportive measures to the affected muscles. 
Scoiiaab b warned against, and b frequently o\*er- 
kwked at thb time. 

The second stage usually huts about two yean, 
and during thb period the restoration of the maxi- 
mum function of the affected muscles b most im- 
portant, and here prolonged muscle training under 
intelligent super\'bion b needed. Lovett warns 
against too long recumbency. The patient should 
be gotten up as soon as the first stage b over, and 
if there b any tendencv to deformity it should be 
corrected by the use of retention apparatus. The 
author's experience with the various forms of elec- 
tricity does not justify its use. Masaage has its limit 
in the stimulation of circulation, and local heat b of 
equal value. Underuse of the affected miadea ia 
preferable to overuse, which may do a great deal of 
permanent injury. 

In the third stage the operative field of tendon- 
transplantation and fixation, attnylectomy, the 
use of silk ligaments, and arthrodem are diacumed 
with their various indications and results. The 
silk ligaments have been itted by Lovett with fair 
success. Cvsns Lix Hau. 



SURGERY OF THE SPINAL COLUMN AND CORD 



IUdtoa«J.: Two Gaoas of ScoUoala. Accompanied by 
Pr sae ur s Paralysis of the l.owcr Umbs. J 
Am. M. Alt.. iQt6. Uvii. goj. 

The association of a motor spastic paralyab of 
the legs with scoiiosb b regarded by the author as 
unique. 

One case occurred in a well-developed girl of 
eleven, who had a left dorsal right lumbar curvature 
with marketl rotation. Two yw% after the first 
observation she developed a spasticity of the legs 
with e ia gge ia ted reffesea and loss of qiUnctcr con- 



trol. Roentgen pictures at thb time showed wedg* 
ing of the vertebne amerioriy and to the right. 
Neurological examination showed no dUturbaaoe of 
sensation, no evidence of cranial nerve palsy, normal 
eye-grounds, upper Hmhs normal, lower limbs show- 
ed greatly exagoerated k n ee- J e ita , ankle rionaa, 
and poaitive BaHnaki on both tides. The neurolo- 
gist's opinion was that there waa preaaure on the 
cord in the region of the donal bend. After four 
months' treatment on a Bradford frame she showed 
im p ro v ement, reflexes and ataxia diminished and 



49 



INTBRNATIONAL ABSTRACT OF SIHGERY 



ncgftiivr .\MllMr 
•I iM» iUm mm iImi • 

Mfd VMHlOT ffOM tW WtHCll 

TW oiImt tarn wat • girl of i6 
blidt at Unli Md WM rtianM la 
Ml ca n y ataw of tlw 



had a^^ 



At ioHtoMi ikt bifaa to Iom 



■nofifc, wpidaMy la iW hp, aad tetBjr boeaoM 
e— |WiH|| pafalywd la tiM lop. RowtfM pic- 
t«No iliowid iliMnwtlwi of four of the donal vtrto- 
freai iIh fourth to the tevtath hot thb 
to ho dao to tahorcaknb. Afttr 
i finm t hot was 
W. A. CuuLtL 



hnl 
dU Ml 



forftos 



r. K.t 

Yoan* Dwadoii. 



hi 



TiMMor of Two 

itS. J , 1916, cluv, 



TW aolhor rrports a case of iatratpiiul iuomk 
■01 OModated with paia. aad calk atteotioo to a 
laadki 



) hjr CoUao aad llarka that the tcnn aiypi- 
cal ho dbcaraod frooi the qrauoauuoloBr of cord 



aiypkaL 



icaraod Ifooi the nmuoa 
PilaleMly advaadag taaMm are aot 
They fona a dletnct aad Uaportant 
groop nwrv rfpijraai hacaaii Icie tangible thao 
daaacal icrka. 

The principal feature* of the author's case were 
a aB i hoia i,lfleiof heateeaee^ p c faer v a tiooof eenteof 
loach; later the gait ** nif^ ataxic aad Bahiaski't 
riga waa poritlve. At luat It was thought to be a 
case of syriafoaqrtia, but ultUaately the degree 
of spiaal uasaiiaMai, comMaod with change in the 
soaaoffv loviL aagpttod the wplrinn of a tumor, 
aad a huabactoair was advbed. 
At operatioa a iiuaor prissated at the fifth dorsal 



level, Ifffsgvlar In oalJIao, BoaMnii^ 4 by I cm., tad 
ohowB adcrasooplcaMy 10 ho a ibrasaroooM. Tho 
pailaal aMdt a poHoct opsrathro aad f^iactiooal 

D.L. 



Vaa I wal a wsa h a ri . J. O.i HawsJiioHiw flMl 
t— bar la Raiatioa to Bacftadie. / Ukk. Si. 
M. Sec., 1916, SY, 4*a 

The aolhor caUs attention 10 ihc vanabuity of 
the stniciwo of tho ftfth lumbar veitabra as to 
slae aad positloa, the niatioo to the levd of the Olac 
crests, hs incUttaiioo to tho vertical aib aad la tho 
pUacs of the poeterior aftkniatloos. Ro oa^ihi^ 
iiaes the changes In form aad ilso la laloral pioesnss, 
whether elongated, traacatod. 0atleaed off, or 
otherwise shaped to conform with sdjaosat lateral 
bodies of the sacrum. Attlmesthnr( 
articulation with the opposing sanaea. 
rior aichm sIm may show auuqr 

When ihb body shows e^ridaaca of' 
dmagss, such aa obscaio articalatiooa aad Hppiag of 
the amrdas, tho comBtloa Is caOod 
of the fiftn lumbar vertebra. The abac 
bearing of the spine in thess coatftioas Is 
aad cotain symptoms caasad by the ooatfiion are 
carefully gone Ima Ho bsBaves the rstloaal treat- 
meat is rest aad mwhanlral support. Operatioas 
are diflkalt in this region ^ad seem to the author 
eaoeatttagly daaosfoos bscaass of resohlag paraly- 
sis, aad viijatttiad bsoaass of the tsadeacy to 
unoalaace a straaure already suffering from aso- 
chanical weakness. He beUoves tho best trsatoMal 
will be immobOiaatioo or ftxatloa of the aiscted 
ports. C C CaAfnanw. 



SURGERY OF liiL NERVOUS SYSTEM 



tnl iiiieailgartime Ro- 
tatlottof Perfpheral 

ifahenr Nervea). IV. 
Xi Kmtk. 'Smrg. Ctmg^ Cueisberg, 1916. July. 

oa rabbits have shown that in 




hcieroplasiic tiaasalaalalioas a coomlste a ec w 
of the trsasplaiitod asrvo occaa wliha twdvo 
loanosa dart; whsnas hooso> aad autoplastic 

aWalMaa 
aprollfara- 
I the traas- 



kthtvils 

tlbi of Sc h w aaa^ eels aa proof of Kfo la the traas- 

The saiariag was doae with a vasdined 

thmad, aad the poiat of smare was tubbed with 

aloplastic 

>of asrvo fftrib faam the osalial oad won 

aad the ttaasplaal acts asa Dissivo spHat 

far tho powlag ihem. Oao haadrsd days after the 

aa slsflrical iiswiaailna fsvo posltlvo 

aad the ' 



The method certainly deserves a plaoe in ths clin- 
ical treatment of nerve defecta. In the litorature 
there tre reported 3a cases of aervo-traaspfauttaiioa 
— only 1 in the but 10 years. Dean ea apkyod the 
sensory portion of the raifial nerve of the forsarm 
to cover a defect in the radial asrvo of the upper arm 
aad obtaiaed a good resrit. Tho author rsoom* 
OMads the ase of the laloroootal asrvas which ars 
very thick aad caa earily be outursd. 



Saittt-MarUa. E.t 

Orafn (Koto sar qorinoss cm de grafes de caooi- 

ChoOC). BmO- «< ai«- .Sar. iW thif. i* Far . toi6. 

dll,i46g. 

Saiat-liaitia has ased caoutchouc (or Isolstioa 
tabes la cams of Mhsiatod aorves, sad 
tabes have basa poiiKtIy tolssatod. la a 

I a teotido waa nplaced by a samB ban of black 
tho siae of a trfn*! • ff ^ ^f ^ f^ sah> 



GENERAL SURGERY — MISCELL,\NEOUS 



43 



•eqaent to castratioo, and without the p«tieot'» 
knowledge, the ball wm perfectly tolerated and two 
monUit later the patient was rid of all anxiety 
rcfarding the loea. 

However in seven atteopCs to consol i date the 
wall by ftpongea of caoutchouc in loopa of inguinal 



hernia, all failed. The fragmonla of ca ou t c h ouc 
were either removed or eliminatfid 

The author b of the opiaioa tluu FIokU's method 
ihould not be condemned at he attributea the faOttrm 
to the bad quality and dafectivo ■terffiaation of 
the ipontw employed. W. A. Banwaw. 



MISCELLANEOUS 



CUmCAL BIITITIIS — TUMORS, ULCERS, 
ABSCESSES, ETC 

Clariu J. G.: Phaaca of the Gaaoar ProMctn. J . 
M. Sm., N. J., 1916. nii, 461. 

The cancer problem is discussed from the stand- 
point of the laity and a rowrt made of the use of 
radium in carcinoma of the uterus. The author 
holds that in the early recognition and treatment of 
cancer lies the hope of a cure. This is the motto 
adopted bv the American Society for the Control of 
Cancer. He lays q>ecial emphasis on the treatment 
of ulcerated areas which have not healed promptly. 
Cancer is primarily a local disease. He thinks that 
the profession will in a short time be held responsible 
if they advise delay in a case of questioiuble growths. 
He does not believe that heredity plays any part in 
its development. 

Clark has found that in treating cancer of the 
cervix with radium of too- milligram doses that his 
end-reaulta are much better; that the stay in the 
hospital b considerably shortened: and that owing 
to the knowledge of the sad experience that others 
have had with the doaage, they have been able to 
avoid such results. He believes that no operation 
should be done on a cancer case previously treated 
by radium. 

Removal of the uterus in cases of cancer of the 
fundus has yielded such good results that the author 
does not feel justified in taking any chances with 
radium. In borderline cases of cancer of the cer\'ix 
he employs radium. In doubtful cases of cancer of 
the fundus he invariably pcriorms a hysterectomy. 
As a palliative agent the author feels that he has 
never obtained results with any other method 
that have approached in beneficence those secured 
by radium. The doud, however, that hangs over 
radium treatment b the danger of unbridled opti- 
mism. HAUtY G. SbOAM. 



W. J.; Precanccroua 
Camtm KtSMrek, 1916. i. j4j. 

The author protests against the use of the term 
precancerous as applied to dermatosea. He com- 
pares the microaoopic pictures found in varioos 
dermatoaea that are tisually called precancefoos 
with the pictures of sections where cancer has 
already developed and finds them to be identical. 
Of all the conoitions called precancerous, xeroderma 
pigmentosum b the only one which invariably b. 



The author insists that precancerous b the wrong 
term to apply to any dennatosia, becanse of the 
fact that cancer doea not develop in a lane nropor* 
tion of them. He suggests that the use of tne term 
dcrmatosb be modified with the statement that 
" the tendency b very strong that cancer will occur." 

HAaav G. Sloax. 



Grubbe, E. H.: One Hundred Thirty-nine 

of Skin Cancer Curod by X-Raya. aimifm*, 
Chicago, (916, xxxvii, 389. 

The author considers a proper selection of cases a 
prime essential for a fair eanmate of the value of 
roentgen treatment in skin cancers. He regards aa 
ideal cases tho«e in which the lesion b primary in tho 
skin or mucous membrane, in which no mcfsttssca 
are present, and which have not yet extended to the 
submucous structures. He believes in 0ving maa* 
sive doses, enough to produce dedded inWammatonr 
reaction, to secure best resulta. He prefers soft 
tubes backing up a 1 to j-inch spark. 

In thb paper he confinea himself to a considera- 
tion uf 1 55 uiKMMnplicated cases which he haa treated 
exclusively by the roentgen ray. Practically all of 
these were confirmed as to diagnoais by microscopic 
examination; IJ9 of them were clinically cured, 
remaining free from recurrence from one to fourteen 
years. Tlie remaining t6 were either lost tiAi of 
or died from some intercurrent disease or acodet. 
The abridged historiea of a number of typical cases 
are included as evidence of the efficacy of the treat- 
ment. 

In conclusion. Grubbe states that in view of the 
lessei»ed frequency of recurrence after thb treat- 
ment, the decreased tendenqr to metastases inaa- 
much as no blood-vesseb are opened up for the 
spread of cancer<elb, and as it b a simple, safe, 
painless, non-confining, and non-disfignring treat- 
ment it sboold be used In every caae of wnmwpH- 
catod sUn cancer. Anoini HAanmo. 

Rcfaud. Cand Nogler.T.: Ci 
aod RadioloaUr llUtory of 
Treated by the X-Rava (Hbtofae 
logkioe Ci radiologkiMe d ua my a esa rc oais 
ks rayoes x). /. * ra/W., 1916, ii, 1 js. 

The authors refer to a previous series of experi- 
mental researches carried out by them on the testick 
in which they were convinced of the Imptfihiliiy 
of cvring by radioatcfilisation. By improviaf tkt 




P^ 



DITBRNATIOIIAL ABSTRACT OF SURGKRY 



I. 



lamon 




tuttvt ns/Ki 
• MM of 
wHIi a 

ofMOCMi. Uadir 
tliff/tiiiiad town 1911 to 1914 A'l«|t 
nek I— dH> Mid oteotoid wwirinhli 
Mid mm apmmu oho, boi la ooly nn c«m» did 
tlHjr MccM«{ in (ttfteg o caaor oouldc tW lUi 



of iaioikotioii and «tto4ouMi- 
bjr i to wv a i of tbt IrTadUlod 



Ao AMlyife of iImm obMrvoikMw thevt ouay 
itMOM lor fittnrr in ikr tne of ihr Xrajn. but OM 
of tW aoil importAAt »•* quiir oaeipfctod. 
TUa li UmI Um mdtocsMibUiiy of a tumor to the 
X-ffogw dWalikM aoeording a» it b Mibjactcd to 
'w&eeamtm &atm tad aooMilawa to a MriUnt ^>niy- 
A ilmtad ymotf b ghta of the X-ray treat- 
I of aayaoMicoaMiiiuaicd in the righl toBpoco* 
bk m M of ttvdvo ywn. Tha 
■•d Mflpanhk, waa Mbjcctcd to 
It X*ffnr ifWUMBla. tW im two treatmcata 
uiuiiafiil tiiariitwiWi iladaailna la ihii tim nf ihi 
taaMT. hM tht hurttiafian nodacad ao naolt. 
It mm cvbbai thai the liiliMMMiMily of the tumor 



la the aathora*^ oobdoa, dJaiiaaffcia of radioKo- 
Attiy b cndaiaabli by aa aato4aramaintioo of 
the aooplaidccifc ijainit the afhcia of the rays. 
Thb iaiMaaiHtioa b co a d l tlna a l oa hoaioral oaodi- 
icatioa dae to the waorpttoa of the wacte of accro- 
biotkcdb. 

TW theory aad cvnaat practke of radiothcra^ 
iadkaie that the traatawat of a maH g a a al tamor 
^ the X ray» thooM be la ■uccamifi app Hcatkm t. 
titM bciag of veak or amdarate iatcaaity. Ex- 
paibari hai ihm^ thai itrf- f-f— *■« -"t — »*'— 
of the doMce haa ae apiodaole dr awbac ta aad 
Mtahly ao in akin iiinBUiaii Bat la other caaaa 
of the doaifi b a dbpaiMfaf pro- 
k pcrndu aato4flUBaaiaalloa of the 
the raya. Thb b ao la vohuaio- 

~ ' >hT fH«^«f of 

the ate, aa d la caitaiaaamaMia. each aa the ooe 

Thanfoia, whta<i*^ the MMfidal pirt^Hi. the 
thiBMM»aad the ladbMaridqr of a taaMr givm 
hope for ka radkai am by a Mgk iatcaae applka- 
ttoa of the X-ngra|thb l anh o dnw i praferable to 
fractioaal doMa. Howtvcr. ia the cam of volom- 

itherbkofbciflf 

haaca the aathoia 

I of aai|My ofith fadwthcrapy 



to 




the 



thb largkal caiaHafr of 

Aflor a aahabla tiaw haa 

h^plcailoaof 

thafiiluab^aadi; 



by the 
iwahlat from the caavlaio 
of the aiPpliMlr colb, bafoia eargkal opa ra t l oa. 
> Piipafatloa of the n io p laa t i r mtoo for altaHor 
aflcadoaa radtothmpruik ttaa im i t by the ra- 
aMval of all vbiUe pant o( the aaopiam. 

4. PraplQfhuda of l a taii aa ca by Moparativa 
tiaatamati. W. A. Biuuua. 

SUA, VACCUfl8» AHD fBftMBBTt 



_.r.M.;Tliel 
CM). SI. J. Mtd. tgi6. Mkv, 4$* 

The author deddad to verify or refute coalradic- 
tory viewa upoa the awotod pointt by trying out the 
teat upon 127 iadividaab. 

The tcau ware aiade by m aa ne of aareral polyv- 
aleat aatifeaa (McNcO'a, HifBchfaldor'a aad that 
nrcpared at the laboratory of Dn. GUmaa aad 
Johaaoa). 

Aooordiag to Krotoas3mcr. the moat importaat 
drawbadi to the accuracy o( the tot Uca in the dif> 
(ereoce in the preparation and efficacy of the aati- 
gen. Another aource of diecrepaacy ia 
may be looked for in the diflcraace of 
the antiffrn. In nine caaca of hb leriea 
with two anlifrn«. ihc potttivr rcaolta were uni- 
formly nnr plus higher with Hinchfclder's than 
vi* ' 'ft anttgrn. 

\\ . irii to mairimooy ia coaaoctioa with 

MMMrrhntw, the test may oocaaioaally add c o a fu rio a 
iMtead of enlightenment. Ia two caadJ da ia a for 
matriawoy, with a former history of ^ 
ao diaical Endinfft. the cowip l fm a a t' 
waa three ptaa poiltlve aad the aath 
MOM of thaaa iadividuab arait be 

dVOBlC flOQOCOCCl*CAfl9CV^ 

The teat aMbiu iu greatcat value ia very fro> 
qaaat caaca of chiOBic proataiitb oa the baria of 
goawrhiBal amttr*—**, *«»«* »■ «b— ■ r— * > nadriif 
reaciJoa b, aipadally la c oaa orti oa with the amr- 
riafe qucatioa. to be tu a ri dere d a atxia iadication 
to poaipoaeaMat of the step aad to viaoroaa local 
and vacdae ireataMat. The best reaafii were ob- 
tained in casca of from eis amatha* to three yaan* 



standing. 

The author b 
futatioa teat for aoaonhom, 
ia coaaoctioa with the cHi 
aid to the 




the 

1 a 

of 



Loma 



dr» 



(Twatmaot wMmtt i i> a cl >q M» dn 
ti mim. 5«r. 4$ Ait. it fm^ 1916 



aabmittcd thb nport, lacaMad the 
of the iherapoatk mothad of La> 



GENERAL SURGERY — MISCELLANEOUS 



4S 



dainche and ValUe dnce thdr fint iw a archu io 
1907. These author*, in thdr raMircbea, nndrrtook 
a double thrrapruttc probl«m: 

I. In the trratmrnt of infected wounds they 
tried to favorably iodueocc the local defense of the 
tiamca by nentraniafkwi ct the mkrohim aeriBa, ca- 
pcdally strcpcocood, stapMocood, and the |>yocy- 
aaic fenaa, aa ««D aa their toiiaa, by meana of a 
senun contaiaing the specific aotflMMfica of these mi> 
CTobian speciea. 

3. Starting from a baab of facta, solidly acquired 
in veterinary nediciae^ rcgardiiii immuniaation 
against a vibriooary form of gaagrene, they believed 
that they could also immuiiiae woundr<l against 
gaseous gaagreoe, and thqr c o as eq u e ntly planned 
a piweatiira aeroiherapeutic treatment 



The authors' polyvalent serum treatment as put 
in practice b a purely local curative treatment, which 
coBsists in placing the polyvalent serum in direct 
contact with the diseased st^ace by means of dresa- 
ings. inhibition appliancea, or injections into cavi- 
ties. A number of reports are subinitted from various 
investigators who have used the serum. These re- 
ports are grouped under the headings: (i) local 
treatment of infected wounds; (a) treatment of 
badly infected wounds with serum, either hsrpoder- 
matically or intravenously, and with or without 
local treatment. 

Regarding wounds of the soft parts without bone 
leaions, local applications of serum show generally 
a considerable diminution of suppuration and 
a great activity in the dcrmatiaation oif the cd^ of 
the wounds. There is much diversity of opinion, 
however, as to the exact action of the serum on the 
microbes. In wounds with oaseoui kriOBS the results 
obtained by surgeons were peneraOy good. The 
subcutaneous or intravenous injection of serum in the 
case of infected wounds or septicemia, while it can- 
not replace surgical intervention b capable of ren- 
dering such interscntion efficacious. 

Quinu. in commenting on these reports, asks what 
place ought to be given poly\'aleat aenim in the treat- 
ment of infected wounds. In what manner does 
it modify the indications of surgery? He thinks that 
every new method which shows some socoesa haa a 
tendency to free itsdf from the restrictions imposed 
by clinical necemitics. Thus the early followers of 
the Carrel method thought th^* could, without dan- 
■er. reduce the amount of clearance in wooada. 
One who followed this procedure had very deplor- 
able results in ao cases treated: j deaths. 4 ampu- 
tations, 5 stationary, and 8 cared. 

The mechanical early aad cooqileie deafaace of 
the wouad b essential to succcm. 

Polyvalent scrum b not an antiseptic; it does not 
kin the microbe; its action b neutralizing by favor- 
ing nucrobe enemies, by neutraUaing toxins, and 
by facilitating the proliferation of reparatory tisane. 
Serum is not a direct combatant of infection, but 
an auziliar>'. 



Therefore, it b not astonishing that wouada treated 
by polyvalent serum should still contain ■ Icr obaa, 
sometimes abundantly, even when the loni aad 
fHMral state shows distinct iapravcaMat. What- 
cw may be the mode in wirfcii tae senua acts, thb 
mode of action impliea the nawasity of direct con- 
tact with the iniurcd tlstaea. Ita action, therefore, 
will be favored by operatory p roce dur es, which 
ojpen up and expose these tisraca aa arach as poa- 
s&le, aad by the surgical reoMival of foreiga bodica 
or dA>rb. Surgical action glvaa a auximum value 
to the effecu oif uacfnl KCTtiona, and c^tecially to 
that of polyvalent serum. 

Regarding the failures of serotherapy, it b well 
known that the antibodica neccsaary for defense 
mast be specific, not alone afainst the species, but 
against the microbian genna. In all attempts at 
immunixation. therefore, with the use of such com- 
plex injections there must be a great deal ot 
speculation. On account of such coati a g enci e a a 
close alliance b necessary between the clinic aad the 
laboratory. The fact that some observations show 
contra-indications or failures does not imply that 
serotherapy b a failure or detract in any way from 
the results already obtained from it. 

In the case of old wounds, with or without scp- 
ticjtmia, Qu^nu thinks that, while c x nerience b 
suffident to attest the fact that pohmilcBt serum 
ought to be included in the means at disposal against 
infeaion, it b not vet suffident to formulate pre- 
cise rules to be laid down with regard to the indi- 
cations for its employment ; more dinical ex p erie n c e 
b necessary. 

The taak of arriving at a definite lu n tluii o n aa to 
the value of the method b rendered awie dUkldt 
by the inequality of the obscrvatioai l ubi ii lUd . 
by the small number of truly scientific obaerva- 
tions, and by the lack of organiaation in the carr>'- 
ing out of experiments The same applies to 
the attempta made to oae polyvalent serum as a 
preventive of gateowt gangrene. 

W. A 



BLOOD 

Pralldi, W. C: Inducad Ls MCu qr t oala na an Aid te 
S uH s ij f. Med. Times. iqiO. sSv. aa^- 

The data of 1 2 cases b reported. In 9 of them 
digalen was administered oraUy over a period of 
time which did not exceed four weeks. In j of the 
cases digalen (1 ccm.) was given intravenously, in 
one of which the second count was made one hour 
after the injection. In 8 of the caaes the patlenu 
were under trcatflsent for aOmenu wirich aeemed to 
contra-indicate the rthihition of an ancstlMic 
until after the rewlu produced in them by the 
digitalb treatment. 

The increaae of the mnUier of Icnoocytca ob- 
served in the 



46 



INTERNATIONAL ABSTRACT OF St'RCERV 





Ttet 


V^htnmm 




il 

t 


51 


s 


3L 


S3 


• 

• 

4 

1 


AIV4MB 


4*» 

Mm 


li 

1 

«• 


tiri 

H— 


i: 

•• 
j» 
I* 
«i 
•• 




M |^2*S 


»»• 




iS 


it 

-.121 



TWrt 



iocmM nor dsomM of Um 
Mr ia CMt 9 after two wwks' 

BDVAID L.COKWSU. 



C. V.I 

Mid. Ktt 



I9t6, «c, 4B7- 

,\tieotkMi fe cdlod to tbe many pitfaO* ia readiag 
aa utoalljr takea by the ordiaary 




BMaMmowatat m tbcy are takea 
bjr tka ouJofity of boty practitJoacn, are 
Vkitf to be owre mfaleaiHng than lignificaat; it b 
oaly bjr wpeatiag tht miaiiiwnumi each niiatite 
(or coca two ndaatee) for a half hoar or Icae, and on 
•evcral wicceMlw dmrt, care being taken in inter- 
prctatioa to avoid aO known tooroee of high iwo- 
•are. that ooa caa be sure of having a rignjftmnt 
•ct of nwiaansMata. 
The aalhor Ims charted all hit blood- prfiUM ia 
Ha draw* the (oUowiag coDdnioot 
which show that: 
Blood>pr«MMW b raised by tones of un- 
aad aotably by aaiiety. 
t. Ia sooM catss, bot by no means in all, it ap- 
ptaci to be tow ad by aU relaaiag pietism feelings 
aad ptcasuiahia i 



I. 



t. It b rahrd by idfilioml brain acdoQ, especial- 
ly by the volaatary work of the eatirs cortai. 

4. The blood-prassore appean to be aa index of 
aaaicty ia the panoa's auad, cooedoMS or sab- 
aad BMy be so need, to mom esteat, for 
nur pose s ia p s yc h opalhology, etc 

fai adalu asfaiaiBdren; ia fact, the widest aornul 
v ariaiiu a the aothor ever notlDd oc cm rad in aa 
iadhridaal, apparsoUy nonaal, who was approach- 
iiW the age of 6a 

6u There b a auukcd degree of reciprocity be* 
twaea dUknat paiu of the body. 

7. Tha dhHlalc b as variable, ia maaj cases, as 
b the sysioBc pTHsare. 

ft. Tae i f i fl fr ff n y rdasatioa of the volaatary 
■asdas readiy aad grsatly lowoa the preasare. 

9. There are avi d eac aa of the frsjiaenry of a 

b great 



aad taatiag aaaagh to ihoruughly mhlasd the dia- 
idaa who aditaEas it far the "sniidpatioa of • 
aaphritia,** for aftaiioadaraab, or (or a siga of goat or 
of Rayaaad's dbaaaa. Low bleoil prwaara iddoai 
has aay moca sfadstarilgBiAcaaoa thaa has low heart • 
rate. 

There are frsqaeat siiagatliHai. aspadally ia the 
diaatnlic reoords, of a raythadc praaaara variation 
of from 15 to JO millimatar^ la wavas from 10 to 
30 miaates long. To ovawo a i a thaaa variatioas 
as aiach as possible the fdkmiag simasllmis are 



I. Twcaty miaates iastead of oaa shoold be 
used in determining a btood-prassars aad the prO' 
oedttre should be carried oat on atvaral days ia- 
staad of 00 one dav only, as b the nwnmnn castom. 

t. No one should intopret aay maasurannni of 
the biood' pre ss ur e save as aa algebraic balance of 
two dooea or so factors and modiners. 

J. A oatient must aot be acatdy aadoas or 
"scared. Me must not be allowed to worry about 
aajrthiag, for andet^ raises the blood-pressure and 
may even sustain it tndefinitdy. 

4. Keep in mind the frequent occurrence ia per* 
soos of cluooic aephritb age of a pressor vaaoootor 
oeuroais, or at least somathing that acu like one. 

EowAio L.Coa»au. 



Cadbury. W. W.i Stodles In Blood-Pi meui s. witli 
Bapwdal ReferaiMa to DIascoUc aad Polea- 
Pressure Headings Ank, /«l. Mtd., igia, svO, 
3«7. 

The purpose of the present paper b to em* 
phasixc the valuable data obtained from diastolic 
and pube-pressure readings. The material form- 
ing tae basb of thb study coasisu of the honital 
reoords of 305 patieats adio eatrred the asedlcal 
service of the Peter Bent Brigham Hospital dariag 
the 3rean 141J. iQU.antl 1015. These 305 patiaata 
were selected from the first t.ooo adnUsdoaa to the 
wards, being all of thoee who bad at least oaa naittiig 
of systolic pressure of 160 mm. of mercury, or asoca, 
aad ia whom at least two tests of the preaaure wara 
made. Siace it b customary to make two or mora 
tests of the blood-pmaure io all nwiiiral cases show- 
ing hypertenaioa or hirpoteasioa, aad since at least 
ooe tfat b aaade of every patiaat admitted, the auth- 
or's study compri s e s very aearly aO the caaea of 
hypertenaioa aaea ia the medical aervice dariag 
these three years. The Faught mercury manometer 
iaatraaaaat was uted in thb work aad the rradlnai 
were made by the ausculutory method. From his 
»tudy the author oondudcs as follows: 

I. Ia the wards of a general hoapital hypertaa- 
sioa oocan almost as fraqaaatly ia feaulea as b 



a. 



About 68 per ceat of caaaa of hyperteaaiea are 
' ia patieau batwaea 40 and 69 yean of ag^ 
tha graatast aaaibar oocarriag batwaea the agaa of 

3. Amwat thrrefourtht of the caaaa, 7J.8 per 



GENERAL SURGERY — MISCELL.\NEOUS 



47 



cent, had rtolinh< rifM of duook nepbritit. Ar> 
rM alio Cloimon. The next moat 
coaditio— were drcvletory dkiurbeacee, 
chrcmic mjrocarditk, or valvular lesions. 

4. If MvenU tpcdincns of urine are examined. 
alhnmin b usually to be found at some time in 
caici of hypertension. If it b persistently absent. 
the cause of the hi^ blood-prosure b generally 
vaacnlar or cardiac dbcase, and not renaL 

5. The readings of the p h enoli iilp boo cp h th a lein 
test vary inversely with the avcnife tjr^oUc and 
diastoHr readings, thb ratio being capeaaUy notice- 
able in dbttolic readings. 

6. The blood urea nitrogen varies directly with 
the average systolic and diastolic readings. 

7. In nypertensioo cases with a normal heart 
load of 40 to 60 per cent, 8$ per cent had chronic 
nephritis. Of those cases in which the load was 
under 40 or over 60 per cent, only about 70 per cent 
were cases of nephritis. When the load was 
tinder 40 per cent the prognoab proved to be most 
vafavorable, but there were several cases without 
fligiiB of cardiac decompensation. Among those 
whose heart load was 40 to 60 per cent, only 28 
per cent gave signs of cardiac decompensation: of 
those whose heart load was 61 to qq per cent, there 
were SQ per cent with cardiac decompensation, and 
of those whose load was 100 per cent or more, 66 

Grr cent showed signs of cardiac decompensation, 
ypertrophy of the heart without decompensatkm 
was most common in cases with a normal load; 
when the load was 100 per cent or over there were 
the fewest cases of heart h>'pertrophy without de- 
compensation and the greatest number of decom- 
pensated hearts. 

8. Subnormal diastolic pressures suggest the 
presence of aortic regurgitation and the absence of 
chronic nephritis. With the rise in diastolic pres- 
sure the incidence of aortic regurgitation rapidly 
dacicaied and the percentage of nephritis steadily 
iacreaaed, much more consbtently than when the 
systolic pressure alone was examined. 

9. During the ho^Mtal treatment there was 
usoally adeCTeaaeinthesystolic, diastolic, and pulse- 
picasurcs, but thb was more frequent with the sys- 
tolic than with the diastolic or pulse-pressure. The 
picssures may rise or remain about the same. 

to. In cardiac decompensation the effect of 
digitalb WM rather to increase pobe-preasore and 
systolic pressure and cause a fall in the diastolic 
pressure. 

ti. Deaths in hypertension patients most fre- 
quently occurred between the aces of 40 and 60 
years, and the underlying condition was ettber 
chronic nephritb or chronic disease of the heart, or 
a combination of the two. More than half the 
deaths occurred with symptoms of unemia or apo- 
plexy. Twenty-ei^t per cent die<i with signs of 
p rog ress ive heart-failure. The patients in more 
than half the fatal cases had had a qrstolic pressure 
of over 200 mm. and 86 per cent bad had diastolic 
pressure of over 100 mm. Gsoaas B. Bbut. 



Timnldifo, P. W.. and Stebbtag. G. P.t Tb« la- 
traveoeoa lajectloa «f Onrgsn Cns as a Theew- 
pruilc Meaanro. Lsm€M, Load.. 1916, czd. jai. 

Experiments have been carried oat repeaiedly 
open animab to show the effect of intraveaoos ii^ 
jection of oxygen. The authors* work was dooe 
wholly upon num and the series indndes several 
desperate cases with marited cjraaosis. He found 
that from soo to 1,000 ccni. of oxjrgen can be in- 
troduced into the veins at the rate of from 600 to 
I, soo ccm. per hour. Cyanoab and dyspnoea ars 
rapidly relieved. The rate usnaOy used was 500 
ccm. per hour. The more cyanoaed the better b 
a rapid rate tolerated. The <M>iect of the paper b 
merely to point out the poaBil:^ty of thb method 
as a therapeutic agent. J. H. Sutas. 

Bardicr and Clcrmoot: Arterial Cootractlll^ aad 
Storalne inCofUMCtion wiih Blood-TnuMmlaa 
(A prvoos de U traiulimua «iu MOf cootractffitt 
arttnefle ct stovain). Presst mSi., 1916, p. 415. 

Both in man and in animals the radial artery, on 
account of its anatomic constitution, very easfly 
contracts under the influence of the mechanical 
excitation produced by its denudation in blood- 
tra^usions, etc. In blood-transfittiaaa'the vaia^ 
tion of the sanguinary withdrawal d epen d s on maajr 
factors, such as the dimensions of the artery, toe 
arterial pressure, and the intensity of the arterial 
pulsations. 

Bardicr and Clermont propose to utilise the vaso> 
dilatory action of stovaine in overcoming the vaso- 
constrictor reflex of the radial artery. Experiments 
made by treating the arterial wall with a stovaine 
solution of 1 :20 showed that there was a disappear- 
ance of constriction, and the arterial diameter re- 
sumed its normal dimensions, pulsations were clearly 
felt, and the blood flow regular. Clinically these 
results have been verified in two transftaions dooe 
in the ambulance service. The method acconUaf 
to the author b simple and b capable of ledadaf the 
measurement of withdrawab in blood-tt an s fu sl n na 
to a regular and uniform method. 

W. A. Baawiait. 

BLOOD AND LYMPH VESSELS 

Gebele: Anooriams Duo to Gooaboc li^|iM«aa 

(Ueber Aaeuryimea durch Schutsvcrlctsaaim). 
Btilr. t. Uim. Ckir., 1916. c, KritfM^- Btft, 5$. 

In the Franco-German War of 1870-71 there were 
reports of only 44 gunshot injury aneurisma on the 
German side. In the Russo-JafKnoe War 8S cases 
were reported. Inthe war of 191 »- 13. there were 105 
cases in the Servian army. In Apnl. 191 S. Bier at 
Brusseb reported on loi aneurisms o b s en re d in the 
present war, 100 of which had bean previously re- 
ported. 

Gebele now reports on 1 a cases of ane ur i sa B a ob- 
served by him in the Reserve Hospital at Munich 
from October. 1914. to January, 1916. and reviews 
the treatment of war aneurbaa at length. Clinkal 



INTERNATIONAL ABSTRACT OF SURGERY 



ditafli of Uft CMM an giv«k 8tv«i of O tbt k 't 

tfMtod by Hptwt Md s by toliift of 

J of iht taller bdM taUral tad « dfmtar 

TWiv WM am Wb-UMntaaiaiioB^Of 

IM OpMSlOd CMW • won VMMONd M fOC tWiOtf 

a bocMM oaii, a com* (om of wMdl «m mi tbto- 
huohr lMMl«i com) diid. Tbt Hfuwo* wort mm 

Voanitr mmwo b Um UmI o pifaUoa tad b tho 

tfCOUOOOft of CaMHO M CKOMHt MMHiHM if AhASM IOC 

fmort •■rrkt b to bt tiptrtod FIumm b ooly 
lobeopoaodfaiobMordiipotoltorilfttofo. Un- 
fortaaaiialsr vmmI Mtwi ctWMt ohr«jr»bt twclod, 
In infection MMwt b €oatr»4Miicatod boctMt of 
ibc (Ungrf of tbroMboth aad Mooaduy h— lOf' 
riMic. to «ydi Biar. voa Bonin. Hou Md ocboft 
abo ivfor. In mkIi cmm lixaiurr b adviiad. 
Ugaiwa b paradMibb in lilliir vwiab, la wUdi 
tba httamBiioB of tba ciradalloa b vithoat daofar. 
Bbr baa drawn ratbcr narrow lindla for Uda, coo* 
ftafaM the proccdttrr to the A tcnporaHa, ibe A 
orri|iilaib. the A ulnarb. and the A tibialb anika. 
Hou. bowrvrr. Mrriclwa the limit and indudca the 
caioib cstcma, the menin a r a media, the truncits 
tlqrfaocarvicalb, the cobitani, and pefoaaa With 
rafani to Ifatwca atlbe rila of iba injury when there 
b an aoita bainiwibagii. Hou baa roooaunandad in 
ancb caaca probing of the vrweb in the periphery 
of tbe toaor. dampinn. rroprninf o( the wk. and 
eapoanrr of the vaacular injury. If branches com- 
■aaicatr witliin the temporary oompraarioa bnn- 
orrbaye roniiniMi Tbao digital fu ni p cq aio o with- 
in the aaaafbai b aaoaiaary, ami Miturc or lisaiurc is 
indicated. 

In acala bamiaihagi Biar reooouBaada Mitute of 
tbe blaadfaig wooad. lamponada of opea cavitiea, 
aainra of tba twfafr wovod, aad cooBpremioo baa- 
dagt. Tbe pciaanr atanncbing of tbe blood moat 
be the final oaa; that ia, antare of tbe vaaad moat 
follow immaiBairty. la aaaariaaw oaa aboold 
acvcr be aalbiad witb Ugatora oa tba afbcied apot. 
la a irital bMBonbaga HfBtaio b oriy tba priiaanr 
act of ddfadta blood — f ■«' i^ ' ^ Tbaa Gabala 
baa obaanrod a aiortal batawrbageTrom an anetirbm 
of tba caroib csieroa in apite of i(» bcinx ligated. 
Ha caaaidan that tba astlnalioa of the aac tn old 
aaaatbaaa b aaoaMary. if taarcbjr aarve adhcaiona 
aad aarva paialfria caa be obviated. 

Tbara b ao cartala oiterloa of coBalaral cirruU- 
tioa. AcoarAag to Moakowica, coOataral drcnla* 
tioa dapaada woa tba poaar of tba baait, tba coa- 
ditioa of tba lawal aafc. aad aaatoaric aaoaulba. 
.\ccordiag to vaa Boafai ibara ara aba to ba coa- 
aidarad tba age of the paibat,tbaakao( tba aaaaibm. 
tba alaie of tbe tiaaaaa tbera. aad tbe tiaatmeat of 
tba vaia. Hoia dbpataa tba aaaanlaa that tbe 
■ niaadiy b more iiipiawd to aacraaia, tbe aMm 
ceatraly tbe Ugaiara b placed. Uaatare of tbe 
aiBaib aad faawrala caaHaaab b atfd to be with- 
oat daaaar; wbareaa Hgatan of tbe faaaoralb oadar- 
aaatb tbe profaada or of tbe bracbialb aaderaeatb 
tba cbcaaafaaa baawrl b baaaidoaa. Ugatara of 



tbe popUlea b aald to be abaoat alwaya foOovod 
by gii^aaa Hou b farther of tbe oalaioa that 
coBataial clwalailna b aafavorably latMaacad by 
baaMffbaga aad tiaaae latttratioa. 

la aiaadaiag tba colataral dmdaiioa 
aiakaaaaa o f tbaawlbod of Cbaaea (Heab) 
ooauMaaa: coaipNMoa of tba arterica. 
of the vaaaab, aad vaatitatloa of the 
vaacttUr ottraadUaa. SboaM Mood i*»uc rrom tbe 
peripheral cad, tbafe aia. according to Coaaaa, 
•uAdent coUatcrab praaent. It b 
thai tbb b aot certain if the 



from tba capOlariea about the outer acripbacy 
of tbe aatraadty. Wbaa after Mctiooiag tae artery 
there b a aagatlva laaalt there raqulaa oahr the 
aae of the aatiire. According to voa Friacb tba 
iadicaiion of a veaoaa vafbs b aa caaaatiaUy aMKb 
more certain aiaa of tba paripberal blood aoflkbacy 
than the arterial banaorrbaga from the perip h era l 
•tump. 

Cmlateral naminaiioa according to KorotkofI, 
i.e.. pompreaalon of tbe arterv aiiovc tbe aaeariam 

ooidiag to the Riva-Rocd method b wMcb tbe 
blood^piaaaore ahould coataia at laat jo mm. 
qoiduuver. is lidicvcd by Dilgcr. voa Boaia aad 
others to be unreliable. 

Moakowica, who has introduced and reooauaaadad 
active hypenrmia (or the determination of tbe bafgbl 
of the arterial doaure in gikigreae of tbe foot, laea 
as a collateral indication a robber baadagr. wUcb 
he applies for two minutca below tbe aaeorisaa. 
Then ae prcaaes the artery agaiaat the boae until 
all pubatioo in the sac has ccaaed. If the coOaterab 
are able to perform their duty, then hypenrmia 
sboold react upon aiMrmia, lastead of the tube- 
bandage, Moakowica aava it b aafficient to raise tbe 
arm or lag aad lower tbe body. Plenteous hyper- 
■ada ia apbe of caayraaaiiiii of the mala aitcry b, 
fai lloakowics'a opioioa. a positive sign of aulBne a i 
collateral circtilaiioo. In all caaea in which tbb 
trial of hyperemia reaulu negatively, if tbe 
ditioa of the patient doea aot ramara ' 
operation. Moskowics repeau tae o , 
treatment until the hypernaia trial becoMaa poal- 
live. In operations wUch canaot be poalpoaad, 
or arbea tbe carotb b iavolved. be reooanaoada tbe 
coatractioa of tbe aatrient artery aad tbe latrodac* 
tioa of tbe collateral drrtUatioo by free traaaplaau- 
tioa of f aacial atsipa. 

OwiM 
valaaol I 

b forced to adopt suture 

baa ligature, in thr irratmaat of 

A triumt>h of «uturinf b tbe 

of abot-away eatreaatiea, «Hdcb 

aaooaaaf vl ia a f ew caaea. Tbaa 

av, abnt up in the foftram of Pracaqral, aad aa- 
aaatdy dying a Sibariaa prboaer, carad wilb 
good faactioaal reaalt a mnabot woaad of tbe appar- 
ana« with ii||ary of tbe baaOfc veia of the branial 
artery aad fwaaartod vdaa, with aapaiation of tba 



; to tbe Impoaaibility of aacertalaiaf tba 
tba collataral cbcalaiioo without falL tba 



GENERAL SURGERY — MISCELLANEOUS 



40 



and ulnar nerve* ol the bkcfw muade, the 
brachialU intcrnus. and (he (riccpa.aa well as a frac- 
ture of the humerus at the juncture of the upper to 
the middle third. \V. A. BaaNXAJi. 

Raid. M. R.: Pvttel Ocdualon of Cba Awta with 
the Metallic Band: Obaarradoaa oo Blood- 
Piaeaiif and Chaniea In the Arterial WalU. 
J . E*p i/rrf . iyi(« t\iv, J87. 

la all except one of the aortic experiments d 
Habtcd and the author the coostricting aliuninum 
bawl was applied to the abdominal aorta bdow its 
inferior mesenteric branch. At the time of their 
inal ofaaervaticNM on these animab records were 
made of the blood-ptcasmcs in the femoral and caro- 
tid arteries. Obnously. in order to draw anv coo- 
daskms as to the effect of the band 00 the blood- 
pvcasure below the site of the constriction, the 
nonnal rtlatioo between the pressures in these two 
vnacb nmst be known. 

In a series of experiments performed by Dawson 
on dogs, it was leame«l that the pulse-pressure in 
the femoral arter>' is normally about twice as hi|^ 
as in the carotid. The femoral systolic pressure is 
higher and the diastolic prcsstue lower than the 
co rre sp onding pcewurei in the carotid artery. 

After partial occhnion of the aorta the systolic 
pccssure in the femoral b markedly lowered. This 
lowering of the sjrstoUc pressure is due mainly to a 
fall in the poise-pressure, for the diastolic presstire 
remains almost stationary, or may be actually in- 
creased. In the cases of most marked dilatation the 
femoral pube-pressare was only about one-half the 
carotid pulse- pressure, while the femoral diastolic 
was actually greater than the carotid diastolic pres- 
sure. 

During the first hour after the application of a 
moderately tight band the femoral pressures tmdergo 
marked changes. At first the systolic and diastouc 
pressures are both lowered. In a few minutes the 
diastolic pre mure may become even greater than 
before the application of the band, while the systolic 
b still subnormal. 

.After complete occlusion of the aorta the nonnal 
blood-pressure relation between the femoral and 
carotid arteries may, ultimately, in some instances, 
be re-established. 

In some cases in which the band has been loosely 
applied, only sBAt gross alteration in the wall of the 
vessel tinder the muid b found, even after six months. 
On removal of the band the plications of the wall can 
be unfolded, and the intima presents a smooth, 
normal looking surface. 

For a short distance below the site of the band 
there b luually a definite atrophy of the elastic and 
muscular tissues. The connective tissue through- 
out the wall of the arterv seemed to be little affected 
in amount in the dilated portion of the vessel. 

At the site of the band the new wall that forms 
over it b c om p oaed mainly of fibrous tissue. Thus 
far none of the author's cases haa shown icfeneration 
of the elastic tissue in thb new wall, he states. 



In the fibrous cord which occasionally forms under 
the tightly rollc<l tund no renudns of the vessel wall 
have been found. It is thought probable that the 
original arterial wall undetfoes complete atroplnr 
and absorption in these cas es, and that the cylindrf- 
cal cord found under the band consists of new- 
tissue which, growing in from above and below, 
rrplarrs the old. This cylindrical fibrous cotd may 
be highly vasculariaed. The author haa found no 
evidence of union between the apposed intimal sur- 
faces. GcooGS E. Bcuav. 

Halatcd. W. S.: .An Rxpertmcncal 8cud||r of Glr- 

cunucribrd IMIatatiun of an Artsnr lUMBetfi* 
aiely Distal to a Partiiilly OcdttOhii Bnad. 
and Its Bearing on the IMIatatton oflba Sob* 
clavlan Artrr> Obarord in Orlain Gaaaa o( 
Ccnical Rib. J. Exp. Jittd., 1916. xztv, >7i. 

From a careful study of the original reports of 
7 16 cases of cervical rib, Habted found that aneurism 
or dilatation of the subclavian artery was noted in 
27 or more of them, including 6 in which the surgeon 
bdieved that the vessel was abnormally large, and 
} in which the aneurism appeared promptly after 
removal of the supernumerary rib. He belie^Ts 
t hat t here may have been other instances of dilatation 
of the subclavian associated with cervical rib. in 
which the amount of arterial expansion could not 
be determincfl in the lack of a standard of com- 
parison. 

Thb experimental study b based upon observa- 
tions upon 30 dogs with aortic constriction. In 
these 30 dogs there was pronounced dilatation for a 
short distance of the voseb below the band in 7. 
or 2yi per cent. 

From Habted's observations and experiments he 
believes that the intimal surfaces of arteriea brouglu 
intact in apposition, whether by ligature or l^band. 
have never united. This, he states, b at variance 
with the quite universally accepted >new that un- 
crushed intimal surfaces if brought gently in coo- 
tact adhere and thus occlude the artery. In the 
author's opinion the pressure necessary to bring 
about the complete dosure of the aorta causes atro- 
phy of the arterial wall under the band, and union 
of the apposed surfaces thus deprived of their blood 
supply does not occur. 

The process of occlusion, he believes, b S0M»> 
what as follows: The death of the arterial «■■ 
having been brought about by the pressure of the 
band, a gradual substitution or orgsniaation of the 
necrotic tissue takes place, the new blood-vessds 
penetrating it from both ends. The ahaoqition of 
the lifeless wall proceeds oo-oedinatcljr with ka 
vascularitation or organisation. He gives tW 
following summary of Im sttidy: 

I. .A partially ocdude d artefy may dilate <fisul 
to the site of constriction. 

a. The dilauiion b dfcu —ai bcd. 

3. I^lien the constriction Im 
in amount or complete, dilatation 
observed. 



I ciilMr slight 



INTERNATIUNAL ABSTRACT OF StKGUlY 



4. TWdfaUtiM wMfTMiMivkrti ihclumeAof 
ikt Mt«y (llw MfU) «M ndwad to ooe^Uilfd 
V of tes OlifiMl iiM. 

I of ilttMbdaviM anaiy 

itvoa or Moct Uoms la 

ofcaivicalrib. 

^ TW dibiatioo of Um Mbckvita fe drcMH 

•cribid. b dhul to Um polM of coooifktion. tmd 

•islkl^y fMonUM llw dBouuioo vkidi iMi bwa 



or ponMBt onMOWflli of I 

$. Panodoaorioiirii 

km boM obMTvod tiraat 



7 
llw 



TIWflHMritOft 

ibcMu dBotoUoa ocamiag villi ctrvkal rib 
lylbtMUM. 



"CIS 

c— iiiciort Um moUc pi— m o oMsr bo por- 
— oaUyootowowdaad tboHi i ao Uc pmMiit to la* 
cf ■oiiJ UMt tbo ndm^tmmn k gwouy diminiiboH 



of Um aoru b coooidiribly 
oUc uwowiii OMV bo 



^ TIm ciponMOMoftr prodncod duotoUoi 
Ulo ommImm oftbtMbdaviaa oncry ia co 
corvicol rib ait probably aol doe to varooMCor 
paialjnii, traaaM, or oaddMi variatioat ia blood* 



la Tbe abaoraul, wbirtpool-Uke play of the 
blood ia tbo nlallvchr doad podtac iosl bdow tbe 
Ao of ibe loan tic tloa, aad Um lowered pobe- 
piwui aMy be Um cbM facton ooaocraed ia tbe 
pratecUoaoif tbedflaUooa. 

It. IoUbmI Mifaoai broagbt, bowev tr ceaUir. 
ia coQtact by baadi or Hotano do oot. ia tbe 
aatbor** irpiiriaarii. aaito by fint iateaUoa, for 
Um font aeooMaiy to oodade tbt aiteiy it tailiritat 
to caaie atcrorii of tbt arterial wmIL 

IS. Baadt, rolled ever to tifhtly. do aot rupture 
tbe imime 

ij. Tbe death of tlie anerial wall luving beeo 
bioagbl aboot by tbe praMuit of tbe bead, a grad- 
aal tabiiiiaiiaa of tbe aecrotic tiaeae takes place, 
Um atw v eawl* penetratini^ it from both eada. Tbe 

'"^ beHevea it is in (hu manner that aa artery 
ocdadod, and it ia tbua tiMt a 6broaa oord 
vitbia Ukt coostrictiag baad. 

E. BcasY. 



lIPBUlIBirrAL SUKGEKT AHD SURGICAL 
AJIATOMT 

ttmmuG.tl^niWw§^.I,U.i TboHpiataaiiai 
UboratfoMof taliifbiia flkoaa Um ftdieaale 
J. tkmmmtl, trSpTtk^p.. 1016. viB, 470. 

It boa btca ataicd by varioaa wriitn that cpi- 



it IBMratod Ifooi tlM aditaala aador caperi* 
coadkioM ia Ult abttacc of aiUidal otJaw. 
laUoa of Um 9laadHdoi, aad that tbe Iflnraiiim ia 
Um iaiopity of 

■ptytefUMI il it air I warily 
aad aot oadtod OMrriy by 
tbt abaormal itatory niaialiiinn. the 
aad oilMr facton iiMatilwf with ibr 

la tbt piawt caaditioB of the queMioa 
tplMpbria b Mnaaiy.or at loaot aad« oi|. ■ ■, 
tal coadhloM, ihoa oa to tbt blood by tbt aitmaali 



ia tbo abitaot of trtlAdal tHt ^t***^ atiaudatiMi* 
it aoooMd dtrimMi to tbt aatbort to try aiilbodi 
ItM opta to obltctloa» oipodaVy to far tt tbo dftor* 
adaauoa of tilt tnwaiH of tpiaepbria Hbtcatod 
to coBctra td. At nfoidi tbt fartbor nawUoa 
wbotber afltr itctioa of tbt H'l«»'^«fc^ ^ ^^ 
rbaiii to ooaipltttly aboltobtd or oaly diariirfihtd, 
tbtydoaotattbowlttopoMlblttotatMaritbytbt 

apoa vat oc o a n rictor raactioat of tbt tttt oQocu. 
Tbt aatbon bavt tadcavorMi to tirwcoaii tbto 
diftcvity by ariag a aiethad which doot aot laoaiit 
iritbdrawal of tbt blood to be tcated, aaaMty* eoutc- 
tioa of adioaal voia blood ia a pocfctt of voaa cava, 
wMcb to tbta lolitud. Tbt pwaww of tpiatpbria 
ia tbt blood to dtdaotd from iu actioo apoa tbt 
dtatrvattd irto or alctitaUi^ OMaibraat. aad apoa 
tbt blood^rtaMire of tbt laaM aabaaLTbt idml- 
ftcatloa of tbt cbaait ia tbt Uood-pntMio carve 



for 



p io d actd by tp ia ap h ria to areatly aaafaftd by aimul- 
uuMoaa obatrvatioa of tat eve raactlooa. The 
•■io^iif of epiaepbria liberated caa bo taUaMltd 
by iadtatiag tbt dlea oa tbe bkwd'p rt i uf t corvt 
1^ the inieoioa of appropriate amoanf of adreoaUa 
in salt lolMtioa. 

Cau were t am lo y ed in the great aujority of the 
autlMir't experioMata. A few dogi wove used for 

Tbe apoataaeooB liberatioo of epiaoibria ha* 
beta itaditd (ia tbe cat) by aeaat of the (dtaer- 
vatcd) eye reacliooa aad tbe blood- pru e ar e oaafca 
caused 1^ blood from Um adreaato wliaa ptraiitted 
to paaa bto tiM circulatioa from a pocatt of the 
veoa cava in which it liaa beea coll ect od ia kaowa 
amnanta and for luiowa perioda of Ume. 

Siace the blood to not withdrawn from tbe 
vemito, the uncertainty introduced by tbt raaid 
dtvriopment in tbe blood of p r emor boditt arlacb 
•hnaiatt tbt action of epiaepbria oa aome of the 
objecu BMat faaoraUv ottd u biologi ca l 
that aabttaaot to tffwftff «*"* 

Tbt aimaltaaeooa obaervatioo of tbe eye 
gwatiyaidaiatbeiatorpiotatioaof tbeblood' pr tm ur e 
carvca wbea tbt tawaat of efwawplirin to aaauL 

Tbt approx^ — '^ -««ay (witboat withdrawal of 
blood) of the< . in the blood coUocted ia the 

cava pocket 1 -^rcoato by tbt iaitctioo 

ofvanriagdu m geaeially pr ataa i i ao 

dificaky. It tiiu>i ut ■•■^*. from tint to tiaM 

ia tbt ooont of aa osp 'hen the 

of tbt aalmal chaafM. 1 uc wuuuoi of 
HiiialiBiiiaril Ifttiattd ia cau waa f oaad to vary 
ia difmaft iipiriiaaati tdtbia a rather aaoow 

(frooi ooooS to oooaS a^ per miaou ptr aafaaal, 
or boat o.oooi to 0.001 mg. per miattt per kilo 
ofaidaMl). 

Aflor ttctioa of botb iywtpatbetif trunka ia tbr 
tbom aoar tbe diapbn^as iartadJM tbe oMjor 
Miaachaka, tbt noaCMtaM Wwr^ir*^ of tpi- 
aapWatocoaylttttysbBfcbid DMrioaof tbtauilor 



GENERAL St RGERY — MISCELLANEOUS 



SI 



tpbaduiict in the Abdomen don not necoMfily 
aiiise tolml cnMtioo ol the lecretioo in all cats. 
In ooe animal a detectable amount waa Mill liberated, 
but the liberation was entinhr slopped when all 
the fiber* coming to the umBiinsr faogUon were 
cut. 

The fall of blood-pressure caused by section of 
both ^anchaics has nothing to do with the failure 
ol the adrenab to liberate epinephrin, the auihora 
state. For when the nerves of the right gland alone 
are <fivided and the left adrenal vetn <£pped, the 
blood collected from the right adrenal in the cava 
pocket vidds no epinephrin reactions on release of 
the pocket. 

Although, as M known, cats survive indefinitely 
the removal ol one adrenal and divUon ol the nerve 
sopphr ol the other, no detectable epinephrin was 
found in the blood coming from the remaining adre- 
nal five weeks after the operation. Good reactions 
were obtained on mamsiim the gland. 

No increase in the cpinephnn liberation was de- 
tret able when sensory nerves (brachial) were 
»ittnttlated. If any increase was produced by 
asphyntia in the author's observations it was very 
slight. GcoacK E. BaiLsy. 

Mnrahnli. E. K., Jr.. and DavU. D. M.: The In- 
•nsBcs ol tho Adrannk on the Kidneys. /. 
Pkanmactl. trExf. Tkerap., 1916, viii, $3$. 

In the course of an investigation on the distri- 
bution ol urea in body fluids and tissues, the authors 
had occasion to analyze the tissues from two dogs 
which had died as the result ol double adrenal extir- 
pation. These showed about five times the normal 
content ol urea. TUs rather suggested that after 
the removal of the adrenal glands from •««w«^U 
there exists either a condition ol renal insufficiency 
or a greatly increased protein catabolisnL The 
present investigation was undertaken to determine 
whether an accumulatioo of nitrogenous producu in 
the blood and tissues was a constant condition after 
tKimphtt removal ol the adretial glands, whether 
i n cmncd protein catabolism or renal insufficiency 
or both were essential to explain these changes, and 
whether or ix)t an intcrrdatiooship between the 
adrenab and kidneys existed. 

In operating, the adrenal was removed through a 
^ iT*^^ sr f^ii^Vf* itartiwg near the CTstal margin and 
raudng generally pu»Uel to the fibers ol the trans- 
vcnalis muscle. The lumbar vein was tied and 
cot on both sides of the gland, the gland ioosrncd 
wp by blunt dissection aided by a traction suture 
plaoed through it, and finally snipped out, dose to 
the capsule, with adssors. The peritoneum was 
then closed over the adrenal site by a runnins or 
piusc - t ring sntnre of fine silk. This procedure 
ttnyt ancited any slight ooung of blood, and 
prevented adhesions. The ri^t adrenal was alwajrs 
r em oved first. Closure was performed in two layers, 
wUh obliteration ol dead spaces. Aseptic precan- 
tkns were observed and there were no Infections. 
The animab were ancsthetiaed with ether given 



by the intratradwal mtlhod. From thdr iavesti- 
gation the authon draw the foBovii^ stunasaiy: 

I. Cau from which both adnnal glands have 
been coni|Hetc|y rcnovM bjr the interval method 
and pftcratiooa a n yloyd bjr Effiott have survived 
from one to ieven days. 

t. The nraa concentration in the blood rises 
after compleu rsaoval of the adranals to abont twice 
the normal value and remains apprasiBatcly stsiion- 
ary at this levd until shortly before death, when it 
again rises. 

3. The pbenolanlnkonerihthalein —cwtlon shows 
a tendency to Mm,aAi^ ^t^r adrcnalectonnr. 

4. Cats with both adrenab removed excrete 
much less tirea and creatinine in the urine after an 
inlection of these substances than normal or singly 
adrenalcctomixed animab. 

5. The kidnevsoladrenalacUNnbedaBlaMb show 
no noticeable histological cbanfe fanm the normal, 
but those of adrenalectomixed animab wUch have 
received an injection of ttrea. creatinine, and soditui 
chloride show a striking change from the control 
animals. 

6. The nitrogen excretion in the urine of adrenal- 
ectomizcd caU is sUghtly AniaUed after the opera- 
tion; the diminution bdng accoumed for by tbe 
retention of nitrogen products in the organism. 
Hence there b no marked change in proldn catabo- 
lism. 

7. The above facts, which have been demoniCntad 
b^ the authors, indicate a marked lowoiaf ol 
kidney cffidency in adrcnalectondxed cats.^Tfab 
may occur with a normal blood-pressure, and when 
the animab are in excellent physical cotuiition. 

8. The bearing of these facts on the interrda- 
tionship of the adrenab and kidneys b ducussed, 
and the excretion of some substance by the adrenab 
which b necessary for the msinfrnanoe ol normal 
kidney function serves as a probable explanation ol 
the results obtained by the authors. 

Gcoacc E. Bcitat. 

Flsishsr, M. S., and Loeb. L.: Further Invcatita- 
tloao on Cbo Haradltary TranunlMioa of the 
PUNrso c ea In Saacoptibillty to the Growth ol 
Transplanted TtuMMra In Varloua Scndna of 
Mica. J. C«tu*r lUtMrtk, 1916. i. jji. 



From experimental study the authors 
that variation of environment does not alter the 
stMcepdhflity to growth of tran^>lanted ttrnwri in 
various strains of mice. It u generally admitted 
that differences in susoeptihilitv to the growtk ol a 
certain tumor in aninub belonging to different 
and yiricitita b based on romi il ul ional 
in these anlmah It haa been shown 
that different strains and families ol mice which 
structurally appear to be identical may differ 
markedly in thdr staoeptibility to the growth of the 
same tumor. Soase are indijied to attribute thb 
difference not so nrach to hereditafy diffawncas aa 
to external conditions snch as diet. Whart aict 
have been transferred from one locaBty to 



5* 



INTKkN.MIONAL AHMK.UT OK SI K(;hKV 



aad tiMraificr thorn chantr* in ike prapoftioo ol iIm 
(ravtll ol limMfiUaicd tumort ii don mN tlMm 
■w—lly Um iW locality rh«ncr U iHr (actor 
ilMt b bMic Ob iI» oilifr luiMi. it b proUble 
iboi utmak Wft Ixm arlcciod la wkom Um 
coo«litto« for IMMT frovtii b mor> (avortbb. 
PtaM lay ttraia of mko It b poMlbb to •elect thooe 
viwo tMt b proboblt. TIm omlwri' obtervatioat 
•koor co a cli M M y tlMt tiMW &§mmcm ore In* 
iHiilod oad Ml difKiljr dw to oMoraal cooditioot. 
riaoe tkejr fouDd ih«i «niMib kept uiKbr Idntkd 
cowBtiooi HMsr m^ H'*»n dUNnaow thfousk o Mfbo 

ofjMMffmtiOM. 

Foar ttniao d«rivtd from variooo locotlona ia 
tbe world wore obocrvod. The aoaUMr of lakoo 
after aa laocalnlnB witli the aaaw tumor aa well aa 
the |u»;oaH§i of tttBMTt fiowiag alter a take rr- 
ouiaed coaataat la thrae atralM* In the fourth 
itiaia aa appareat eaeaptioo to thb rule waa found. 
The eiplanatloa of thb fact b that moat of the 
meaihew of thb itrala wrrr killed off by dbeaae 
early ia the cspeiiaMnt. and the Mirviving memben 
which were daweadaats of an original atrain drmoo- 
•trated that oae of the pure Unca had been bred 
out in which tbe percentafe of aooooMfal iaocuU- 
tiooa reoaained cooataat ia iiwrf leu oeaerationa. 
Gnmth of iancaland tuaMwa ia hybrida betwoca 
aad AoMfkaa mice ahowed that the Ant 
ia both kiada of hybrida waa almoat as 
to the growth of inoculated ttamon aa the 
AaMrican mkr. while in the ieoood geacratioo a 
laaffkod (all in tbe number of defiaitcly growina 
taaMm took place; in the third feoeration the (aU 
waa atm more pcoaouoced. However, in tbe (ourth 
aad fifth geovatioa a decided iaciaaae waa noted. 
Thb faa b at vailaaoe with the experieaoe of 

Hasby G. Suux. 



D.« ana RoaoSt «• M.: The Abooepcioo of 
odMe by tbe Thyiald Glaad In 
VHa, PMawlat Ita Incmveooaa lajoctioo 
to OiMtBM AaaoMila. J. Pktrmmtl. (r Exp 

TklMp.. 1916. via. 4JQ. 

Ia a nrevio ua paper oae of the authora la c oUabora- 
tloa wtth Fcba haa ahowa that artificially perfaaed 
aad aanriviaf thyroids of dogs take up kl very 
rapidly aad retain it in large amount*; that thb 
•r*-— - ' THM sharrd by other tisauea of the body; 
th nhtbit» thb activity aad that oaly sur- 

viving myndd celb manifest thb phenomrnoa. 
At that time two experiment* were rrportc«l in which 
50 aif. Kl were injected intravenously, after the 
iiaiotal of a coatrol tobe of the thyroid. The lobc» 
capaMd to the KI (or oae hour ah owe d practically 
the aaaw aftahy (or thb aah aa waa foaad la the 
te abre pcffaiioaa. 

Ia the pwacat coauaaaiCBtloa the aathora record 
the rrsulis obiaiaed (rom a aeries of jj aaperiawata 
ia which the Kl «rs* introduced intravaaoualy. The 



raw 




of both kidaeyi aad laawvlai oae lobe of the thy- 
roid aa a ooatiol. 90 bm. U hi 1 ccaa. diatilled 
water waa fatjiclad lata the iateraal htgalar viia. or 
oae of lu hraachoa. hthm the thyroid area. Ilhor 
(or aaMthMia waa the oaly drug uMd and ia each 
caae the aaaal aaeptic lechalqae waa foUowod. The 
aalaub ware allowed to Uve (or p«toda of s aimitos, 
10 adaatea, 1 hour. 4 hoaia. 8 hoaia, la honra, 16 
hoara, so hours. >4 houra. and jo hoan foOowiag 
the lajcctioo of KI. In four eaperimea ta — two 
of 5 minutes' duration, and two of to adaotca* 
duratioo — the reaal veaaeb were 
Then the lodiaod Mbea were laaMvad* 
email aectloaa takaa (or hiatology. aad thai 
of the thyroid, tonther with piaoeaof Uver aad aploea 
deaiccated for iodlaa daCarmlaatiooa. The thyroid 
loboa laad varied nuikadly in %ue. in iodiae oootcat, 
aad ph yaiotodc activity, aa indicated by the raan 
of histological appoaraacea (rom qoieaoeat or col- 
loid to marked active hyperplaaia « 

Aa ahown in the te tiire perfaaions the amoant 
of KI abaorbed neceaaarfly variea with the satface 
espoacd (alxe of glands) and tbe atage of phyaiolog- 
ical activity — colloid or normal glanda ahowing 
the leaat increase in iodine. Any analyria of the 
qiuntities of iodine abaorbed (rom a given doee 
aniat take into consideration both tbe s&e aad the 
stage of physiologic activity of the glaada need. 

There b apparently no difference, tht aathon 
state, betweca ia eilre aad ia tiae p e rfuai oa a aa re- 
gards tbe peroeatage of iodine abaorbed. The 
abaorption is practically instantaneoua in eadi 
caae. Ifaiimum thyroid effects are orodaced by 
audi exoeedinciy small amounts of iodine and the 
gbnd haa ma aa eitraordiaary alfiaity (or aalis 
of iodine, that iu loaa throufh the Udaev may be 
considrrrd negligible, and thb probabhr aokb true 
for all other body tiaaaea. The aiae of the glaad and 
the stage of p hy riologi c a l activity modify the aawaat 
of KI abaorbed apparently to the aaaw degree 
whether it b introduced by in ritro perfoaion or in- 
jected intravenoualy in the living animaL 

Thr li\-er and niaea ahow no retcatloa of KI. 
whether introdaoea by la tilre perfaaioa or by ia- 
travrnou* injection. With 
KI introduced and with gUada of aiodlar 
of physiologic activity there b ao 
differeaoe ia the Mroaatafe abaorbed, 
ia tbe p er f urfoa laau 1 hoar or jo ' 
maat be 



aBA laciaaae la the 
laalacbdoaaiathe 




or hoara of a givce experimcat. bat h waa aol aof- 
fidcally marked to be detected aa ao iacreaae la the 
iotfne content of tbe thyroid In thb aariea of 
glamU with tbe methoda eauloyad. althoagh after 
one hour it wm aot prcoent in deteciahb aawaau 
la the drculatba. Gsoaoa E. Biaav. 



waa aa (oOowa: In aU but 
Boaia, dap «bh framhr ealargrd thy- 
aaed. Altar IfBllBg the laaal vasacb 



.C.: TheTrawphmteHoooltheThytald 

Glaad to Ooga. Am. J. il Si . 1916. dii. mS. 
The author brkffy reviewa the aubject of traaa- 
piaatatioa of tiaaoe aad orfaaa aa autografu or 



GENEIL\L SURGERY — \f ISCELL.\NEOUS 



53 



homopUst*. and raporu to caact of traoipUat- 
ation of the thyroid gland with the iiynrnt of 
the carotid artery, « of theae caaei bedg auto- 
plaaia, and the rpmaining 27 homoplaati, In three 
imtancw in the latter group the parathyroid ^and 
remained in a normal atate of preaervatioo, while 
the thyroid gland showed evidenoea of antolyaia. 
In the former group of three cases they succeeded 
in retaining the thyroid gland in its normal state, 
iiitftw f oiA'aii y^ in a cases. 

Reprding the transplanted blood-vessels. The 
carotid artery remain<^cl free from thrombosis in 
»< cases, the thyroid gland in 4 cases, although the 
gland transplanted had undergone autolysis and 
waa partly absorbed. The author bettevea that 
aototransplantation is practicable, however, and 
coododea that at the present time there are no 
meaaa of prolonging indefinitely the life of an organ 
tran^anted from one animal to another. 

Hexby J. Van okm Bcxc. 

Uolman. W. L.: The Classmcstlon of Strepto- 
cocci. J. Mtd. Reuarck, toi6, zxxiv, 377. 

During the last few years the author has had the 
opportunity of studying large numbers of strepto- 
cocci from a great variety of sources. These in- 
dnded strains from general surgical material, blood 
and throat cultures, materials from the obstetrician, 
gynecologist, otolaryngologist, ophthalmologist, and 
ocl^rs, strains isolated at autoosies from man and 
animals, and a variety from milk and other sources. 
During this time his chief endeavor has been to 
d i a o over the best method for isolation of these or- 
ganisms, and the media most favorable for their 
growth. In many cases great difficulty was en- 
GOontered in obtaining pure cultures where other 
organisms were present m the material. In other 
cases it was sometimes a problem to obtain satis- 
factory growth, even when the organisms were 
isolated. From his extensive and careful study 
the author draws the following coodusioos: 

I. A simplified and practical method to dasaify 
streptococd b desirable, and the combination oif 
Gordon'a carbohydrate fermentation and Schott- 
muller's blood agar tests, modified for practical pur- 
poses, offers the most useful means to this end. 

a. Coaatancy of these reactions is essential to 
the method here advocated. Evidence of trans- 
natation or riamples of inherent alteration of 
character have been instifRfient to invalidate this 
method, The confusion In the results of these tcsu, 
and moat of the examines of so<aUed alterations 
are eiplainable by the Relative difficulty of growth 
and the morphological similarity among the differ- 
ent tjmes. Mixed cultures are ditTacult to detect 
•ad often hard to separate, and the strains vary 
widely in thdr longevity and resisting power. 
Alterations in vigor of crowth must be guarded by 
aring the most favorable media and nrtfnding the 
of observation. Animal experiments are un- 
e, owing to the high invasive power of strepto- 
cocd of the animal itself. 



y Standard osethoda ahoald be followed. The 
carbohydrate aeram brath, deacilbed hy the aathor, 
and five per oeat dafUMiaaled hamaa blood acw 
offer the oeM media for this paipoee. QaaalitMva 
carbohydrau add tesu by litraitloa are aot ■§ ai^ 
fnl aa the qualitative tests. They add 



naaeoeasary labor without any oocieipoadfaMt ad- 
vantage. Andrade's decolorised acid fadMin b 
an eimnently satisfactory fa<Bcator for qanlitativa 
tesu. 

4. The classifying of streptococd by the method 
here outlined can be earned out in the roatiae 
baaeriology of any laboratory. It is onaeeoMtty 
to make it a spedal research problem. 

5. The author's method for carrying out the 
classification is briefly as follows: All material ia 
cultured in serum broth before plating 00 blood 
agar. The cultures are tested on blood-acar slants 
for hemolysis, and in lactose, manntt, saSdn, aad 
inulin serum broth for fermentative power, over a 
period of at least seven davs. 

6. By this method of daasification is 
the hjemolprtic and noo-hcmoljrtic groapL 
each of which eight subgro ups are arraoged. 

7. Much information of practical importance 
concerning streptococd b made available k^ the use 
of this method of rlsssificstion. Many of the 
air streptococd can be traced to theb sooroes, and 
the same is true of streptococd fouitd in milk, the 
mouth, the intestinal tract, animal ttasoes, and other 
places. 

8. The individual groupa of sticptocood are not 
specific in their disease prodnctioa. The !1^fw^^^PT^ 
of the hemolytic group are coounooly more virvleat 
and pathogenic, produdng p rogwa si ve diaaase 
processes more rapidly than those of the virkiana 
group. 

9. .\lmost all streptococd have relativdy hi^ 
invasive powers, and the varying cooditiona of 
lowered resistance play a most important rAle ia 
determining the type of infection. TUb b ttftdaXtf 
true in the chronic infections. 

10. Focal areas of streptococcns infection often 
contain more than one tyie of streptococcus. The 
apparent alteration of cnaracter of the strepto- 
cocd in these cases b due to the confusion arbing 
from the mixtures. In the mouth, intestinal tract, 
the vagina, and in other regions, the entire flora, 
induding the streptococd, may rapidly dmafa 
with the alteration of the local eaviroaaMat. 

11. It is believed that with the adopcioa of thb 
rlsssificstion greater uniformity will be reishlhhed 
for the comparative analyab in the study of atnpco* 
coed. Gaoaos £. Bblst. 



iMMiy. B. A.: 
ccmlng dm Bypsbkyila «f dm 

cioon I ipsriawisirs acsrca dt 
1). /Vmm mii., Argnit., 1916. 



VkaiCIav 
Is hfaoia 



(laissiigs 
' de b 



The aathor haa nude a number of eapedawau oa 
the commoa Aifeatiae frog, I t iUi t t t M t ewiibw. 
Previous experimental work aioag the sum laea 



54 



OmUtNATIONAL ABSTRACT OF SURGERY 



MbvCtnl 
flic. wiMM tmmM Um 
pmn» with Us 
I. Iht liipup^rii oMrittt ol Uat putt 



tjmi vkli •vUm dUhwulnloii: (t) 



two 

«hli iddopyit gnaahtloM Md with fatty 

J. loibrfragihcbypoMyafeb 
to cxkicocr; but iu toul raaovil 
la • Uwrt tist, apptrsotly iadip«Ml«thr «f aojr 
opcrmtivfl ifaMUliMk Lmc Mvvhral it, OQwv««r, 



iwiiiliiioiinlii iri!S" riltn 



4. qpirauirt maaipalatloat, letviBf the hy> 
ill itt pMidfliib ptnnit a loaf Mnrlval aad 



dbaialril tk» nles 



ft. HyMpkjmiy auact of trap ooDtaiai Mb- 
•iMKO vlridi omimm oftorisl pcwMio um iocraoM 
tiM cwdiic •ytiolc WMfjr, wbich bft vo a galoctafQf> 

OW liClilH. wkidl MMIM0I thfl OBOOplHIfBOl OOD* 

tracdoM oad whidi^mo tlw Udacy vMida and 

pmAnr* (iiurMia. W. A- Bbkwmam. 



WaddcO, J. A.i TiM PhMmTiiloty of Um Vm 

J. tkmwutti tf Bsp. Tlm^p., 1916. 

TIm aatlMT icDoru tJw renlu ohtainrrf with 
i difcnalla of ibiflp^ ^^QPi 

TIm dragi MMwcre epi* 



tiM 






^ ^ ^ liooiiBai riifff i roii w^ 

pllviiary otract, aad boiiui ddoride. 

la the caac of tiM dop, rabbits, rata, aod guioca 
pipw the orfaa was r em ovod oader compirte ether 
or ddoeoform iMwihrrifl; ia that of the ahoqi It 
waa obtained fioai the caica« of a (reihiy tlaagh- 
lorad laaU» at the dty abattoir. There waa an 
iatorval of about two boat dapeiag betwcca tlw 
death of iIk ibeep and tlw bcgittDii^{ of tltt eiper* 
dariaf which time the orfaa waa iLcpcaa a 



^ glifli iinptMiwid bottle. Ia 

when labotateiy aaioMla were aaed, the orgaa waa 




to the 

TW 

aO the aatlMT^ 

ia brief aa ioHowa 
A piece of the vaa 



from the 



waa the oae —ployed to 

The p r oc ed are waa 




■tripped of all ear- 

^ t to s OL to length, 

waa attached by one enw d ly 10 a italloaary hook 
aad by the other whh a dPt thwad to a lever, the 
Ma of which wera nmded on a ilooly 
draaiu The tietae with ita attarhtd hook 
' to aa nrjriMaied bath of Tyrode't 




for eaBolyiac fieih 

to a 



ftoid. The 

a Were 
witha 



heat legalator of aaftdeai delicacy to amiaiato 
the ten^Mratttie at i7-iS*C. 
Flam hie tiody the aathor amkea the foOowiag 



The freehly odaed vaia dalOTMto of the rabbit 
and the rat oihibit rhythmic ooatractiona when 
to oiypaited Tyrode'a or Rinpr** 



aomtionat body taaperainie. 

The vaaa doMWito of dom rabbita, ratiL gi 
pif^ aad theep addhit iacnneed tone and rhyt! 



COBK WCUOQ0 UDOB ftSDBGttUOB 01 CDiOCDS^bAa tffflDV ■ 

hvdraetiaiae, pilo car p ia e, nitotiae, and bantmi 
chloride. All parts of the organ nact emen 
aHke. 

Pituitary estraa prodacad no etfea on the 
quiceccot vasa deferntia of anr of the anlauls 
csamiaed. 

The vaa deferens b a very t eip ouri fe aad very 
reiimiil oraan aad it may prove of valoe to the 
phjfdolo^cal f* ft****ft iHffe!iirn of tef^aift dm0. 
the aathor b e lie wa. He alraady haa aader way 
(unher iavcettoatlon of the teactiona of the v;>* 
defereaa. and oTother portioas of the male geaer 
tract, which wHI be reported at an early date :.. 

O ro fl f O fl £. 

Hi, M. I.t 



The T em p er a tMre ReacHone In 
J. Uk. if aim. Mti.. 1916. i. 90J 

Thb research was undertslien by the author 
with s view of aacertaiaioc ii possible the nwrc 
immediate caosea te e p o niib le for the tompecataia 
chsngee observed to anaphylactic snimala Remote 
cauaea were not fowid e i a d In other words, the 
porpoae of the rtiearch waa not to tovcetlgate the 
menianlam of anaphylaxit, but rather to learn nmrt 
ddtoitdy the mcduudsm that cauaea the anaphy- 
lactic temperature changea. b the anaphylactic 
riae in temperature dae to inaeaaed metaboUHn, 
or b it the reaalt of lemenad heat diaatoatioa? Is 
thb fever comparable with aauiu g eaic lever, or b 
it Biore to the aatore of trae tofoctiona fever? 
What rdatkm do such dmgi aa are ganerally held 
to deprem the acndtiventaa of the heat ceMma bear 
to thb type of fever? It b queetiona of thb char- 
acter that an attempt haa beea amde to 

Rabbiu were uaed for thb work. A 



inita p roca dui a by 
tovarbbly elic^ad. 




The method fnalhr adopted 
coMiated to the aoMitiatioa of the nu lr^ l with 



a COB. of beef 

aDowiag aa facabation period of at leaet two 
and then wdntaftfag the animal with 
cable rmthaetar of biaaf eeraaa, ditatod with Marib 
Bi f iutt! aalt aolatiDa to oae cabic ceatlaMter, Into 
oae of the ear vdaa. Tbb prooedare never iaied 
to elicit a riae to taaqwrature of about one degree C. 
or over withto aboat two hoara of the Jujectlon 
The temperataia a— afcr t a tara ed to aormal to 
aboat iovr or fhfa B(BaB nbaotaMM to the tolection. 
A second riae to VKttutultMn may gaasraVy be 
eHcilad to the aaaw aafaml on the taam day or oa 



GENERAL SURGERY - MISCELLANEOUS 



55 



the (oUowtng day by ft npMted injectioii of the 
■ntiyn SiHfir itow of tbe aatifen, e.g., opo* 
hiiBaradth cttbic coatioMtor injoctod into teiMitiaed 
aaimab, were Just as ceruia in produdng a rise in 
tempenture. dtbough CHMraOy not quite to hij^h. 

A Mirvry ot ihe experiments shows that the rue 
in tempenture in tcnsitizcfl animals (oUowing the 
injection of the aatifen b independent of the 
aljciO|i«B metaboHim. for the praaptacM of the 
fewie reaction and the height it reached in these 
aniBttb in iHiich the gljrootea content was reduced 
to a minimum amount conqiared well with those of 
normal animab with normal givcocen content. It 
was not posrible, however, in these eiperimenu to 
reduce the glycogen to xero, the author states, 
probably beo u Me during the period of rest following 
the strychnine oonvufauoos small amounts of gly- 
cogen such as have been found mi^t have l^n 
formed from the animal's own proteins which it 
■wtaboliaed. A different method was therefore 
morted to in the hope of eliminating all traces of 
glycogen. 

The author's eiperiments show quite conclusively 
that the anaphylactic rise in temperature has 
nothing whatever to do with the glycogen mctab- 
oUam, and that it is of an entirely cufferent nature 
from neurogenic fever. The relation of anaphylactic 
fever to the glycogen content of the ammal, its 
relation to morphine, a drug that depresses the 
aenritivenem of the heat centers, and finally its 
rdation to tbe transection of the spinal cord, the 
author states, ouke it at least highly probable that 
it is of the same nature as true infectious fever. 

GaoacE E. Bkilby. 

Orr, D., aod Row«, R. G.: Toil- Infection of the 
Ceotral Nervous Syst«n : a Clinical and Lxpcrl- 
OMntal Invoadgntloa. Edimh. U. J., 1916. zvii. 

The authors were impressed by the obscurity 
which saiTOonds the genesis of almost all inflam- 
matory lesions in the central nervous qrstem, and 
of those wUch are degenerative except friiere a 
focal lesion «dsta. Th^ note that the questions 
of the canaation of the lesions, the point of origin of 
the morbid change and its propagation are con- 
stantly recurring in regard to cases of meningitis, 
myelitis, tabes dorsalis, dementia paraljrtica, and 
the non-systemic sderoscs, and that the theories 
advanced have often been based on assumptions 
devoid of proof which have tended rather to <fiveft 
the investigator from, than to lead him on to, the 
right path. 

ror years it was apparent that continued exam- 
ination of these chronic lesions while increastna 
knowledfe in detail yet failed to widen it in regard 
to etiology, aod thoui^ toxic iofhience naturally re- 
ceived due recognition, ita source and mechanism of 
action remained unexplained. It seemed obvio us 
to tbe authors, ther ef ore, that invcstjfBtioa ihonld 
be directed toward eloddating the mechanism of 
production of those lesions, and the first step natural- 



ly involved a stndy of all jpomlbk nntha of inlacticn 
and intorication. It Is vttb one of these Infection 
via the lymnhatir tpum of peripheral 
that the main portion of this paper deals. 

The study records the authors' fipfrie nc e aod 
obierrnioni in a number of cfinical caaea, and in 
eadli Instance where possible they have verified these 
results by experimental meana. Instead of lafect- 
ing organisms or toxins Into the nervca on wUdi 
they proposed to make the oboenratiooa, they placed 
a ceBiBkHn capsule containinc a broth cnltare of a 
micro-onanlsm in contact with the nerve. In one 
series of experiments this was placed under the 
gluteal mnsdes alongside the sciatic nerve, in an- 
other series tinder the skin of the cheek. Tbe 
animab experimented imon were rabbita and dogs, 
and the organisms nsea were staphylococcaa pvo> 
genes aureus, bacilhis pvocyaaeos, C^otner's bacuras, 
bacillus coli, badlltts botuUnus, and a culture of a 
diphtheroid bacillus obtained from a case of demen- 
tia paralytica. 

Tile remits of their experiments showed that in- 
fection of the Ijrmph system of peripheral nerves b 
followed by an ascending perineuritis whidi spreads 
to the posterior root ganglia and along the spinal 
roots to the cord. The loose areolar tissoe covering 
the perineurium, the ganglion capsule, and the dora 
mater showed tbe greatest degree of iaflaBflUtioa* 
and along with these fibrous structures formed a 
natural and efficient protection against infection to 
the underiying nervous elements. 

They also undertook an investigation of the lasioaa 
produced by infections occurring from the blood 
stream. In these experiments the abdominal cavity 
was chosen as the site of infection. Tbe reasons for 
choosing this were: (1) the peritoneal cavity b most 
suitable for an experiment in which one wiahea to 
avoid infection of the Ijrmph system of vinal 
nerves; (2) to reproduce as dosdy as possiMe a 
gastro-intcstinal intoxicatioo, and observe the effects 
upon the spinal cord; (j) to ascertain how far such 
toxi-infection affected the sympathetic g*'^gWifii 
chain. Celloidin capsolea containing a broth cnl- 
ture of the staphsrioooccus p y og en e s 
therefore placed in various rcmons of the 
where they became attached to the 
kidney, bladder, or lower border of the st( 
etc. 

On extmi' ^tn g the spinal ooid from thb series of 
eqwrimenu the authors found no evide n c e of hrm- 
pbogenous invasion, either in the sheath of the spiail 
g«n^im, the perineurium of the spinal roota, or in 
either the dura mater or pia-arachnoid. Within 
the cord, however, there were very definite < ' 
which they summariae as follows: (1) The 
highly developed stnaanres, the ner 
least of all. (s) There b primary dafHMntion of 
the ngrdin sheath around the cord nuupa and along 
the poaieromedlaa septum, (j) The myelin defen> 
eration b neatest in the upper part of the cord. 
(4) There b cedema of the cord. (0 Thero b ac- 
tive proliferation of the p e ri vaacmar 



INTERNATIONAL ABSTRACT OF SURGERY 




M) TW v«ttb Ml iMiUrf Md coafMUd, tit Iqrt- 
IM^ tad cMMtte tlwDiM of Um Mat Mttnt. If 
Uhm kt cttlftMtd fdlk tW ctid kiltat fai Ijn^dMC- 

I^THBlHiSHott iMttcUm ii cktitoitdnd bjr (i) ikt 
ittiratiitliJw cdb tf Um fatd ctsMciivt liMMs 
(a) dw B Wi i l i ttri w of tkt crib of tbt tdvMMititl 
riMMlli Of iW voIm ttd ctpBtffkt; Cs) tbt tppttr* 

ii dMaltPtltd; (4) f >■ roll dcfrocrtiioa tad 

_ FIvtii tlM tbovt, tbt mmIiwi 

tktt tiMlaltttia iMMMttofntti iMotict- 

vMy vU^jr faoti iMttfoud itljrfl^pMt* 

'tm, vbtn Um ind UMtti tit tcthrtqr 

tad tl Um iMrbid pkHwacnt tre of 

itofytjrpt. TW dUhnaet boiwoeo the 

two MitfM, UMttioit, tbqr Mtl^ bt tnmtid Sjr 

ttSfiM UMt it IVMBlMMaOti itItcUot UM itdtBI* 

tSk tbrfr tMifamm; fa twt 
ibty tit itdtotd to t adai« 
tad tktf coaridtr Udi t aMtt importaat db- 
n hi atonpttholtBr. 
Ftaai tbe tbovt daictl tad ttptritMattl Mudy 
ll ii cktr Um tbe two iMchtahMt of iaftctioa of the 
ijntoa — tbt botMlapaoai tad 
"tit cbtitcttrfttd bjr itflkitatljr 
1 pbtBMatat; and if the results of the 
tit tppltd to the human Mibkct very 
MJitiara Ii obttiawt in tnrnag tt tn 
_ of tbt fMMrii of ocffttia lesbios. 
The tatbofs btvt r 
to show tbtl tcaU 
tit ittdOx piodaotd of 
IjriBpb qrttcm ia atffVM. TbtylMvepftvkmiljrci- 
pitiitd tbt opitioa tbtt fHMnl ptnJyriiof tlM in- 
taat ii t fltrifiilf iafltauattonr atctteof hrautboc" 
tatat origin. Tbii in?4ftVwi m btsed oa tbt dose 
ilMltiiiy bcfweta tbt vtscaltr ittinaiin tbb coo* 
dhlta tad Unit ftaad ia tbdrctpcrincnu where the 
IjnapbqrttcaiofllMncrvcsoroarawa* infected. The 
iiriBai pctdoadatnce of tdventitUl prolifcnuioo 
aadiaiuaUoa eta be npltinwl only bv toxi-infec- 
tlaa of tbt CM fbrny i a i l lyamb. IlMre b no 
■Hdiac* of t aawrtl blood iatoncatioa, they sttte, 
for la dMaMttt ptitlytict, ttia tbdr apcitncnts, 
tbt tadtcbdhua of tat vtMtb auor be quite un- 
tfccttd, vbik tbt tdvtatitltl ipant tit pt^ed with 
tbt piodacu of ppoHftrttioa. Paitbcr, to tabes 
" tbtittMbr 

taoMrtl 

tbcroot 

nponr tyncaac caaitcttr 01 

iatbtoplaloa iff tbt ti rtbflif , pw tlw tB tty 

B.BaLav. 



IV ■■■■■■ VI wnsui MHimsi 

I iNoattt forward awplt tvidtaot 
tad f*—— 'f** mirclitlc coaiBtloai 
id by laftctioa of tbt ttotadiac 



poiaJbrrii, tbt coaiitat prlaMiy tCtctioa of 
tatiy ttati, tad tbt 



I la. aad Garda, W.t Aa 
of cbttbtof 

clit 

P ka ipp im J. St.. 19*6. si. SI. 

Rptitetattl Study vti ctiUtd oat vitbtbe 
of dtttndalat wbttlyr or aot tbt ast of 

to itaMivt NtMpt btditi frots tbc 



fMalitiorT BtMMH b t Jtttlfbblt attoidait. Tbe 
attboii ntallta tbt dtfaa tbtt btt btMi BMdt tbtt, 
witb tiM tct of voadt^caatid by 
iowatati of tiplitfita ait 
tipti or at Ittit ftdUtttt tbt ti- 
of tbt foitiga body from tbt riipintonr 
fi vtti tMdt uit of la tbiM tmn- 
I of tbt ratdy itipoaat of tbt voaritiBc 
la tbtit tabub to tbt iatramuacular laftc- 
tioa of tpotMrpldat< 

UadvlUtt tClMT taattbtdt tbt titdMtl ctaaalt 
wts laiirttStato tbt trtcbtt tbroagb t ibtrt ladrioa 
la tbt tattrior mtdiaa Uat of tbt atck. IW ta« 
Itul wti tOowcd to reoovtr from tbt laftwKt of 
tbt taMttbait, tad about two boon lattr dlftraat 
dtpt» of obitnictJoa to tbt ptastfi of tb faMo tiM 
trtcbtt wtrt ptodooid by pitdaf a tight dtam oa 
tbt rubbtr toblag coantcttd with tbt (rte tad of tbc 
tfacbttl ctaaula aad by coantftiag tbt niblMr tube 
with abort pboes of gltii toblag wbote <BtiMlcn at 
oat tad had been flamed to about 0^9 aad 1.5 
adlliBMtcrs, reapcctlvdy. Aponorpldat liydro- 
chloride (ai ocm. of a 3 per ceat aolollte ptr bllo> 
grtm of body wd^t) was inlecttd latiaamKalariy 
tt varying intervmb from the ronimsacttMnt of 
itniratory obstructioa. 

Tbt rmults of t heir experiments, the sulboci itttt, 
poiat ooadnsivcly to the impoMibilitv of riinnrfag 
fonimi boditi from tbt trtcatt Iqr tat att of tpo- 
mnrnlrinf It sttms, a>ortottr, tbtt t fordga body 
in tne resoiratory pswagii below the laiyax amy, 
in reality, be driven farther In during tbt cti|y attfi 
of vomiung bocaust of the descent of tbe <fit^utgm 
and doture of the glottb, wbkb in turn ghrt riat to 
the rarefaction of the air in tbt tbortdc cavity aad a 
rushing of tbc air into tbe dtaptr portion of tbe huas. 
When tcntriowi maooot plap tit priiwn la the 
hronfbiolct, tbb auiy bt mora tbta f*«—»t^if i^fa^<i^ 
by tbt jtlamltllag tfftct of tpomorpblat oa tbe 
tfttrtion tad perbtabb of tbe bfonrnioks. which 
may looaen and fscilltste the eipectoration of tbt 
plus tfter vomiiinf . 

nam tbb study, the authors draw tiM foOowiag 

I. Thuisicnt stimulaiioo foUowtd by ptiaMi 
of the vomiting center occun when not taatlbt 
tiled dop arc aapbyxlattd by shutting off the tb 
from the trschet. 

a. Partial asphyxia, sacb tt b p rodactd by it- 
dudnc the lumen of the trtdMt to a drcabr 
iof Of tboot i.s mUlimetcn la diameter, 
tbt tbat rsqubod for tbe eoMCk tctioa of 
pbiatL Tbb b dot, prtMrnmldy. to tbe ' 
trrittbiHty of tbt votaltlac CMttr to . 

J. Tbe intrtpwimnaic pnaaai t b rtbed bf tbt 
coovubive ooatiactita of tiM ■bdotritaj wall which 
occurs duriag vomitiaf, tad tbt Hit of pria tt it 
sccoM to btgia bcfoit tiM pttaift of vondtui tbraagb 
tbc oetopbtfti. 

4. Tbt ^tb riiMilai dtitd duriag tbc tct of 
voodtl^ ti ibowa by tbt mttlMd dmcribtd by tbe 
tutboo. Tbb c oac l a d o a b ftitlMr rinairmiiil by 



GENERAL SURGERY - MISCELLANEOUS 



57 



the obtcnratioo that no cspiration occun during the 
act <rf Tomitim 

5. A ttroog expiratory effort b not produced bn* 
mraiately after the eapiiibion of the vomitut. 

f> The adimnttuatkm of apomorphine cannot 
fi> :!;.>(« the removal of fordfn bodies from the 
tmcbea. Gcoaoa E. BuLav. 



D. E,: Tbo P wl p twial Actkm of Opium 
Alkaloid* Willi apactal iif««M» CO dM Bladder. 



J.Uk.^Oiu. 



., 1916, i, 86>. 



The experiroenta described in this paper prove 
that those opium alkaloids which bdoog to the 
phenanthrene series, i.e., morphine, codeine, 
thabaiae, heroine, dionine, perooine, etc., in larfe 
intravoKNit dotea cause in dofi a profound con- 
traction of the bladder. The authw nas previously 
shown that a similar contraction of the brondiiolea 
b produced by these drugs. Probablv a few of the 
boquinoline opium alkaloids, inrlnding narcotine, 
may abo cause a similar action, he states. He has 
failed in a few experiments to obtain this con- 
traction with some other of these alkaloids, notably 
papaverine, cryptopine, and cotamine. 

.\Dparrnily the contractions of the bladder and 
of the bronchioles produced by these drugs are 
strictly analogous and in all probability of identical 
origin. The contractions in both organs occur 
ftimultaneoosly, are usually of approximately the 
same proportions, last for co rre ip o i id in g periods 
of time, and when the initial contraction b maximal 
then later injections of anv sized doses of either the 
initial drug or of any other of the series will not 
produce anv further contraction whatever of either 
bladder or bronchioles. 

If the initial contraction was not maximal then 
much larger doses of the initial drug or of another 
of the (phenanthrene) series may, the author states, 
caoae a second contraction, but even by p r o cecd i a g 
bv degrees in this manner, a third contraction b 
aunost never obtained. When the bladder and 
bcoachioles have thus lost their susceptibility to 
the action of these opium derivatives, they are 
still found to possess oract ically normal sensitivity to 
all drugs which usually act on them, including lobe- 
line, nicotine, pilocarpine, arecoline, muscarine, 
atropine, barium, vanadium, adrenalin, etc. Pre- 
vious dcMruction of the brain and spinal cord by 
the injection of lobeline or atropine or both does 
not prevent or probably even specifically dcoeaae 
the extent of the reaction to heroine, coddne, 
morphine, etc. The author thinks that possibly 
curare in very larae doses may weaken the response 
of the bladder aadbronchioifs to these opium bodies. 

These reactions closely resemble those produced 
by drugs which first stimulate and secondarily 
paraljne nervous structures, snch, for example, as 
the action of lobeline on f *«fM« But so far as the 
author has been able to determine by pharmaco- 
logical means, no paralyib of either nenrons or 
muscular structtnrca b produced by these alkaloids 
Ordinarily thb action of the opium bodies would be 



attributed to a direct action 00 the musde fibers, 

since it occurs after atropine (and curare). But 

since a bladder which naa become 

immune to further injections of tbeie ol 

may give, so far as he has been able to de u nn i— , 

a piniealy normal re sp ons e, Le., a p io f o nn d 

traction to ordinary doses of barium. 

pilocarpine, muscarine, or even lobeline, he 

unable to see why the loss of re sp onse to the opium 

alkaloids should be attributed to muscular rather 

than to nervooB origin. Gnonoc E. 

RADIOLOGY 
Ledoux-Lebnid, R.: Tho Radloloik 



C assops Gaagrane (Le dhgnnsrfc: ladMaglque 
de U aaagrene gaseuae). J. it ndid. §1 d'iUeL, 
1916, tt. 341. 



The presence of even a small quantity of mu 
in tissues other than the lung which are normally 
deprived of it b shown on the photographic plate 
by a characteristic image. But althtNigh such in- 
stances have been carefully studied by radiologista 
the knowledge has not been classified so aa to fonn a 
source of valuable informatioo to the surgeon. 

The author has had occasion to observe a case of 
gas gangrene which has spread so rapidly as to 
necessitate an amputation of the thigh. On radio- 
graphing the stump the plate revealed comiderahle 
gaseous infiltrations in points where it was noC 
clinically manifested. The author thinks that in 
cases of gaseous gangrene which appear to call for 
amputation, radiography should be used as often aa 
possible, and that the drmonst ration in thb way 
of infiltration along a muscle where there b no 
other indication of its presence would call for 
higher amputation than would otherwise be in- 
dicated. The results obtained would then perhaps 
be better. W. A. BaxsnuM. 

Sholian. J.: Some Theeret lcn l Gonsidcratloiw «• 
the Prsasut Status of Roantgen Ttietapy. 

B0Mi»m y. fr S. J.. 1916. cLksy, jii 

Considering the insurmountable difjioilties and 
the contra^ctory effccu of the roentnen rays in 
its various fields, it b small wonder that greater 
advance has not been made. The author pouus to 
the analgrsir effect of these rays, and the pain 
caused by a bum from them. On the other hand, 
while it will cure some forms of cancer it wfll abo 
cause cancer. Attention b drawn to the vartoos 
staaes in the advance in thb field, but nMie ea- 
pedally advances dae to the various ubsntwiijons of 
different authors upon the physiologic ciecia 
upon the tissnca. Reference b made to Hriarire'a 
researches upon the blood: at fine thoa b a liia 
in the number of white cdb followed by a drop; the 
polynudcar lenoocytes suffer most, then the lympho- 
nrtea. As to the cause of these rhanfie he ONiocas 
Wi^ham: "Every ray that suikas a call, ao 
matter what the source of the ray Is, eicfta some in- 
fluence on that cell. Thb reaction b the lasult^of 



INTERNATIONAL ABSTRACT OF SURGERY 



■MQrMMivuiMtflClOlt. TIM IMMl IsipOftaM OMt 

■ft: (i) tW ilifwi of Um metpMs of iIm cdl, 
i* oUmt trord^ Nt iptdie wMo i— Itinity; (i) Um 



qmatkf of r^ abMmd !■ • mk of Umt; (j) (1m 
wtdic piorfbilly of tlw kiad of nvt; (4) tiM iIom 
tHpriat Uiwccn %kt ndbtion ud ilw hbiologk 
.1; (S) til. flifMlo. of Ih. ray. tl»o«tb 



iho 

A* to tte MiMlhnily of tkt tkmtm he qooloi 
Wtttcnr: **NonMl ll— ■■ hnoplinld ifaMe. tc»> 
iklM Md ovufai, iMial tkia of ckBd, dOld* 
caitJIafi, onicoiM mmrnhntm, hakt MpOl*. clOld't 
bodytbiL iaUao of Mood fMMh. •kin of tht faco 
of UM tdak, tvooi Mid MboMoat giMMb, Akia OD Um 
kpdy id Mod of Um adoll, fhm — d MdMy 1 

of oddl, boM (ol ia Um oidor aaoMd)! 
Umoo ""IndtMBlc oad pooodolovkcnic 
polclMO of 




vidnrii, old poldMi of ponriorfi, roood 
■M, hypomopbc pnatote, hypertrophic luput, 
tiriMVodoM bMt i lwM , miriniwna, myooUc hair, 
hoM tvbcrcvHMM, poiiarHynMloiM floiur, lupus 
diy lona, woitB* lopoo vonuooooOk fibroma, 
i.** The varioM dbooooi tiootea by the 
ray» are cooiidond both faooi the aiohor'a 

vaiioai f oraEuMlhon, and he fonflndio that if the 
bfac hcai c a l theoty fa a ccep ted tharo b a ptoodoe of 
bcttrr dajni for the —Mir*'** caoea. 

W. S. NswooMrr. 



R.t 



oftnortacbo 



Am. J 



ImW.. 1916. tti, jts. 



Ia order ilMt tlM rn< iiigi aologht auy amid 
omo ia readtaf X-rmy piMea of the booea aad 
ioiBta he OMMt poaeeaa adequate kaoorledfe of the 
Mw» of pbyiici fowaiag the rocntgeo ravt aa well 
aa a thorao^ faaflarity with the nonnal roentgen 
•aatoay aad ita auuqr TaiiaUooi, dae to ace aad 
farihriduality. A lack of ataadaidiiatioe b ooe of 
UMBMOicMaaMacaaoaaofcnoriathbwork. The 
opatator OMMl MMko platoo acM wd la g to a otaadaid 
WUch ho haa wodwdMt for MmiiW, or ha mac 
kaov tht tochaiqaa wad la aaUag a ghrea plato, 
befoti ht caa toad aadi plataa aocaiatcly. The 
■aihor cala allatioa to a aaariMr of crroct ooai> 

B.Com&D. 



. J. J.: Tho 
of tho 
M. At$^ totO. lU. J69. 



Stafw bffa^ aiatoa the view oi various rorot- 
inolacbia aa to the pbyokal barfa of tht braached 
ahadov* atoa ia haag plaloa. Ht bditvta the hlh» 



b caaiod by prlawify btaachaa of patmoaary 
HBcbplaa tht waBo of priawgr biaachta of 



^ tOfBUMf with lyaiphalfc fbada aad 
tboat orhirh aoooavaaha theae ainKivr 



the 

altvctaiia. 



btfoithb 



A bfWf otatoBiaai b gNta of tht ithuloaa of tht 
phyiical otgaa to tht rotMMB iadlap boatd 00 a 
atMly of too caaaa. Ht Imi that tht platt la- 
dicatai anich bmco pttholOBC qmumm thaa do tht 
phyricaldiM btotaat • ^^ttaoMMt ia 
aaiy tbaat wiB now voaalMaoiopc 
imrktd taoaili tobt tvldtat by aoacidiatioa. 

Tbt coadiiilooi arriiMd at ait aa foOowt: 

1. A looalMMiraai npraatau oat of tht aM»i 
accoratt alda n duisaoiiac huM coaditloaa, 

a. Whea aa aroa of laag tbaat, aonaaOy db* 
ttadtd with air, b aot dbttadtd with ab oa la« 
iplfatioa, aooM patholo^c oowtttloa b pnaaat — 

3. Wbea the hia§ fa dbttadcd with air, both in 
ia^dratioo aad tipiratlon, we have aa arc* of 



L Tht dtaaer the ialcvlobular markingi the more 
lafittatioB. 

5. Cavltiea, whether filled with poa or brokta 
dowa tbaota. caa readily be detcmdatd by tht 
tttrrooading arfinite ahadow and the abaeaoe of the 
intcrlobuUr markings within. 

6. In earliest dcinooatrabletuberculoaacoBditioaa 
we oat dtlicatt iattrlobobr Uaea appwwrfwutod aad 
appareatly held ao by delicate adherioai — a 
p tov bl on of Nature limiting the affecttd area to 
produce rest and cure — the muscb 
thb area is aoalogoua to abdominal ' 
with iu attendant nraadt q^taaa. 

7. When tttbercalooa patients are forced to 
breathe deeply, by enircMt, hi^h altitodca, or a 
rapid pube from aay other condition, air b foroed 
into theae apparently doatd lobules, ttaiiM op 
delicate adhtMOes; from thb aepanitloa of tat 
alveoli, fever reaolis with poaaible hcmorrhace and 
iacreaae of aevtrity of the towrmia 

8. All platca of adults show some pathologic pro- 
ceaa whica coJaddea well with the fact that acarly 
an adnha react to tuberculin. Davd C Snaoa. 




1016, Bl, 49o> 



bytbaX-Rjgr. 



Before It fa poaaible to interpret a patholon> 
coaditioa, oat aratt have a fairly good co a co ptfc ft 
of tht Bonaal boot with the nuneroua v ari at l cn 
aad fTt*-TrtfrT TMae changea have beta ooaald 
trod uadtr thret heada: (1) thoae wMch would U 
riaariiod audaly aa f reaka of divilopiaal where the 
lalotaMtioa obtainable by roeatfaa anarfnatioa fa 
of odcatlic rather thaa practical vahM; (t) UMoe la 
which the groaa appaaraace ihowa the deforaity aad 
la which the roeatfea ray fa owrely used to give ac- 
curate iafonaatioa aa to the boay elements involvod 
for the correctioa or asodUkatloa; (O the oMat la- 
poitant, that large group of caaea ia which tht roeat 



geaognun givca coadaaivc tvidaaoe of 
which may or auiir aot have hata augpaiad hgr 
aymptoaM, or wUa caaoa ao oyantoaM, bat o0ir 
oibataclca to differeallal dhfaoib whea arddeataUy 



GENERAL SURGERY — MISCELLANEOUS 



59 



Many iUu*tr«ikN» of Umm cUmm are given and 
levcral iaportant facu ate bfooglu (onrard; at 
(or inatanctt, where there haa heen an injury of tome 
pathotogic pfocm to develop the cause, that one 
of theee irregular fondifkMM may eiiat at the same 
time and be tboughi to be the cauee of the suppoied 
malady. In the lumbar region irregular devdop* 
BMBt of the lateral procewi of the Mine or some 
irregular development of the last rib may give 
rise to error in being mistaken for a kidney stone. 
When stttd)ring kinuscs of the head care must be 
taken to coMidcr the normal irregularity of these 
cells, and, furthermore, the thickened bone on one 
side may be perfectly normal and be regarded as a 
new-growth or an inflammatory condition of the 
lining membrane. The irregularity of the teeth is 
a well known fact and they should be carefully 
studied before anv radical measure is undertaken. 
In correcting deformities the roen tg e n ogr a m 
should be carefully made and studied so as to obtain 
t he best possible knowledge of the eiisting c<»ditions. 
.\ttrntioQ is also called to the fact that in the de- 
velopment of the child the parts on the opposite 
side of the body usually develop at the same rate 
and give about the same picture; this is at times 
modified and should always be borne in mind. 

Bransrh, W. P., and Mann, P. C. ; Effects of ReCca- 
tioa In tbm Udncy of Media Employed In 
Pyelography. Am. J. M. 5c., 1916. dit, 336. 

The introduction of opaque media into the 
kidbieys in p3rclogra{Ay is sometimes followed by 
dangnotts symptoms or even death. The authors 
have reported several cases of hjrdrooqthrosb where 
the kidneys were removed following pydogr a phy, 
numerous fod of n e c ro eis in the cortex being 
fomd. 

In order to determine whether thu condition 
was due to the retention of chemical irritants or to 
bacterial infection, a series of experiments was 
performed vpoa dogs. The technique used neces- 
sitated the ligation of the ureter following the 
injection of the solution. As a consequence hydro- 
nephrosis followed and the results of this condition 
had to be differentiated from the action of the 
sohition itself. 

Soltitions of sodium chloride, boric add, sodium 
dtrate, methylene blue, various colloidal silver 
compounds, thorium nitrate, and washed staphylo- 
cc€a were used. The changes due to the injected 
solution itself varied, but in general they coniisted 
of areas of focal necrosis, located usually in the 
cortex, occasionally in the medulla, which appeared 
to be an accumulation of the s u b atan ce injected. 
In some cases infection was superimpoaed upon this 
accumulation. Observations made tend to show 
that the material reached these locations both direct- 
ly through the tubules and indirectly by ahsotption 
into the blood ami lymphatics and excretion by 
the kidneys. 

The cooduskms arrived at as a result of the 
experiments follow: 



I. The great dasfer in rilvcrprapnratlona is their 
retention in adiviljr sarwirtBff Udaeya. 

s. Where multiple afuna of necroiis occur, the 
kidneys should be removed. 

5. Necrosis, the result of infection, may fallow 
the introduction of a ureteral catheter or of bland 
fluids into a pdvb with insufMem , drainage. 

4. Argyrol, coUargol, and cargemos produced 
the most marked changes. The metal itself 
often found in the necrotic areas. Weak 
were apparently as harmful as concentrated 

5. Silver iodide preparations were less kannful 
than colloidal silver preparations. The best pnpn- 
ration of silver iodide was the impimiinn fai quiaoe 
seed emulsion. 

6. Ten and fifteen per cent solutions of thorium 
nitrate thoroughly neutralized were the least harm- 
ful of the opaque preparations used, but the shadows 
were less distinct than with sflver preparatioaa. 

7. Mild chemical irritants, saoi aa 
chloride or boradc add, did not produce 

8. Stronger chemical irritants, such a 
dtrate and 20 per cent thorium nitrate, produced 
lesions apparently due directly to the chemical 
used and not to infection. 

9. Methylene blue produced no lesions. 

G.W.GasB. 

MIUTAJtY SURGERY 

Prascr. J., and Botes, H. J.: Purthcr ObMrmiloao 
on the Treatment of Gas (iangreae by dM 
Intravenous Injection of liypoalora«o Add. 

Brii. M.J., 191b, ii, 171. 

The author reports 7 cases of gas gangrene treated 
by intravenous injections of hjrpochlorous add. 
In 4 of these there was improvement and ultimate 
recovery. Of the j remaining cases which died, one 
case was afterward found not to have been gas 
gangrene and another had shown defim'te improve- 
ment but died after amputation of the thigh. It 
b therefore condudcd that in only one case was there 
an inexplicable failure. 

This method of treatment is directed against the 
toxjrmia of the gas bacillus with the idea that if 
the effects of the toxins are neutralixed the patient 
will then be in better condition to throw off the 
infection. W. A. CLaan. 

Roberts. J. E. II.. and Srarhnm, R. S. S.: TIm 
.SaUt Pack Tmiroent of infected GMHkoC 
Wounds. BrU. It. J., 1916. U. Ut. 

The authors are enthusiastic over the resulu of 
the salt pack treatment in infected gunshot wounds. 
They ha%'c attempted to more or less standanUae 
the treatment of these wounds, but the tieataaat 
necessarily varies with the site, the nature, and the 
degree of infection of the wound. In a general 
way it may be said that the wounds are widely 
opened up, foveign bodies removed, necrotic tiesne 
lining the track excised, hleeding poiau tied with 
catgut, and the salt pack applied. A piece of plaiB 



INTKRNATIONAL ABSTRACT OF SUKOIRY 



fMH», fottr to lii Uycn ikkk, b 
m %9m tmk nk lol ti o ii aad k 
cart Mm lakfli to Mt llMt it eov 



b HflMly wmof out 
laM in ihr wound. 

_ eovffn the whole Mir 

iMt of tSIr vowd. 

It b Iwpwtii tkat tvwy lecMrftib podtat be 
Mtd villi UMiMat. Ait«4»«ratot«blttt«fialt 
■ft piacad ia iW dMpMt part of tba woaad. A 
•tfto af amnt b tWa canicd alt«aat«|]r from aot 
tad of tat waaad to tbt atlMT aad saHMraaa tabliU 
aC Mk laid batvaa tW iaccairfta layan. Whoa 
tW pack boeoBOi iaili a< tli tb t ilda oarface o low 
BMit layiio 01 faaat aia appaod aad over tab a 
tlddi wool itiiBoiic coapaiod of at lean tluct 
bvon. caanlotohr oadrdtagtW Vmh, the wholt 
Miv tlMa frailly baadafid. Tht aotbon Mate they 
havt ItaqpMtly padtad oato onote<t main artoriti 
aad iMivt atvtr foaad a catt m which the tmmI 



Dariaf tW irM tvtaty to twcoty-four houn a 
caplaai owdatjoa of Hnna ocean, but afitr tidt ao 
farthorondatioatalMaplaeo. At tooa as tkc oatcr 
hww of tba drwdag b t c oaii a ioitt thty art rh i a f irt 
arUnat raaovlag tW baadap It b vtry oa- 
partaat tbai tht woaad ba kapt at real. 

TW pabe-rait aad aeaoral coodhioa of the pa- 
licat ait BMcb better hidicatioiw of tbe «cO-bdnf 
of iht woaad tbaa tbe teaiperaiure. 

After a tew day* the outer drcHfaip BMy aendia 
avctyofkaeivtodor. Tbbbdatto d o tB a ^w Moa 
la ihi iliiadi^ ibiiniiilTri 

Tbe aatboia itate tbat it b •oniittaifa dificolt 
to cbai^ tbe oater liriaiiBti vitboat dittarbiag 
tbe deep pack aad tbeyare aov adag deodoraats. 
Tbcy apeak very bighly of Dakia'a chloramine T 



Tbe ladicatloao for chaagiaf tbe pack aic: 
I. A coatlaaa aij^r jbhn ^riM^tatc. 

3! Saddea ovet of aevete paia. Tbb feacrally 
■oaaa tpnadhv gaa iaf cctioo. 

4. A piiJwiiil rbe of teoiperattire for vUcb ao 
other caaK caa be foaad. 

5. A cbai^ for tbe voraeia the patient 'tfeseral 
ceadbioa ia caaca ia wMcb a raind teaiperataie 
barperditod fraa tbe beglaaiat 

ft. Oeaiiv of paa frooi aader tbe edge of the 

dat dtber to tbe dicaa- 

ii^ hiilai beta Itfl aacfeaafed too loag, or haviag 




be lamiliil wbea tli e pack 
ia tbe cifcaa)* 



layer of fnot b found to be 
to tbt vooad aarfaca it b not re- 
bat a aev pack b applad vilMa It. 
Wbea tbe woaad b graaaJatJaj baahbily it b aot 
advhabia to coatiMt tbt tah pack, aad where a 
aaaad b aot data« wdl with a tall pack, aad a purr 
atiipiacoccal iafectioa b pnacat, tbt ate of a 1 
pvocat lalt tolatlaa at a wet tli iaria i, c o i ii laaoai 

be foaad to efect 
P. CBatfooa. 




WMaa. HiJ.t Tlw tacal Tr ea iai eat of B ur aa aa a 

BrM. M. J.. toi6. ii. jit. 



In thb aerita tS catet wart treated, 15 of which 
tic Tbt noMiainc ij were aaplic to a 
graatar or Iom denae. aad ol ihi* nuanber i died. 

Tha irM draw ma b of picric add. aad ii left la 
aihi for two daya u ao tvidtBce of iafectlaa pra> 
aaala itaaif ia the meaatiait A cbaracterialic odor 

PoOowiac tha raoMval of the tot dmdaf a 
aditart of tooal parts of bftrartf add oiataMBt aad 
viitHBi b applb^ pravidteg the bom b ttiU 
aaaptic Borfc ada fooMatalloaa arc uaed in tbe 
prattnct of iaftctioa. A aptdal draviap b rtcooi* 
Bitaded ia boras of tbe eitraeiity wlda aHowa of 
easy reoMval by awraly laoaaaiag a few tapaa. 

The importaace of aaeptk treatmeot of iMtraa 
caaaot be eiaggerated. The turgeoa alaiuld wear 
aterDe glovca aad recoaaixe the earliest aiga of 
infection in order to cooilMit it activdy. 

j. II. Skius. 

HOSPITAL, If EDICOLBOAL, AND MSDICAL 
EDUCATION 

UabUliy for Wroag Dfaganaii Mtd. Rtt., i«t6. 
bDodt. 1091. 

Action was taken againit a doctor for nul- 
practice, the claim being that of wroag iliagnoab 
Tbe plainttflTt injury was treated by the ddeadaat 
aa a nrain, when in fact both the tibia aad fUmla 
t fractured. Tberawaacoa si der a ble ttstimoay, 



aot altogether in luuiaoay, ia icgard totht<Sficalty 
of diagnnaing iajorics to the lower leg aad abo aa to 
metboda of eiaadaatioB, but all apeed that there 
were certain rcoogaiaed tests or esaaBaatioea to 
be made when the diagnnab waa dificalt. each aa 
an X-ray picture and manipwiatioa or awemg of the 
injured part dther with aa aawathftir or witboat, 
the latter being tbe kaat etkieat becaaae of tbe 
limited manipulatioo that caa be dooe oa aooooat 
of the paia cauaed to tbe patieat. 

Tbe ddeadaat ia thb caae dkl not etherise the 
patieat nor have aa X-nv picture taken, rdying 
loldy upoa tbe mawipolatioa of tbe injured porta 



and esuaiaatioo for ddoraaatloa. Hb 
waa wfoog, but the BMra fact that the 
waa wroag woaU be iaiaAdaBt to laader a plqal' 
daa liable for audpradlce. Ia tddh i**iw to tha 
above factt btlag afiowa. tht plaiatlff raaat ahow 
that each aditakt was tht nsak of asglgRBoe or 
cardeaaacas oa the part of the dactor, aad that be 
falkd to enfdoe hb beat Jadpaeat aad akiB ia 
diagmwing tbe plaiatiff*a iapuiss. 

Injury to Nock — Ooaiparlaoo of X>ftay PIctarea. 
Ht4 Mm.. 1016, 

The above 
for iajuries 

alidiag dear belo agla g to tbe dofaadaai. The re- 
viewiag coart bdd tbat the rduad of tbe trial court 



wasbfoagbt by a railroad derk 
asd to Ua ndiaU cdumn by a 



GENER.\L SURGERY — MISCELLANEOUS 



6i 



to allow Doctor Gray, a roentfen-ray eipert, to 
exhibit to the jury an X-ray taken hy him, tbowing 
a man's neck in normal condition, waa an error. 
The plaintiff had introduced into the teatimoov two 
plate* taken by a Uoaor Brady, a phyaicun of 
bnitcd aperience in the ine of the roentfeo ray. 
Tbcae plates would have been meaniaglen to the 
jur^ in the abieoce of an emlaaatioo and interpre- 
tauon by Doctor Brady which disdoaed a fracture 
of the transverse process of the third cervical verte> 
brv. If Doctor Brady's explanation of thoe pic- 
tures had been taken as correct it would have settled 
the cootrovcrted qnestioo of whether certain bones 
in the plaintUTs neck were broken. The plaintiff*s 
attending phjrsidan, however, did not suspea a 
fracture until the pictures taken by Doctor Brady 
were explained to him. Doctor Gray, the eminent 
roent gen-ray expert of large experience, above 
mentioned, testified that the pictures introduced 
by laid Doctor Brady did not support Doaor 
Braids contentions, and said that he could demon- 
strate that fact from the pictures themselves by 
showing to the jury a picture of a man's neck in a 
ikormal oooditioo. The plaintifl objected to the 
introductioii of this piaure. The Court excluded 
it, sajriag that to permit comparison of the plaintiff's 
neck with other necks would lead to confusion. The 
reviewing court stated that it deemed it proper to 
allow the introduction of the pictures offered by 
Doctor Gray, their value as evidence in contradiction 
of the explanation by Doctor Brady of the roentgen 



ray of pUintilTs neck depend 
neaa of a p r rwninin tt that 

ft^>T Tffftt tWtil 



ing upon the correct- 

every nan's neck is 

contrary appears and that the 



meral form of structuie of the neck b the same 
Tlie plaintiff was allowed to introduce a skeleton 
to ahow by way of comnarison all the bones involved 
when in normal condition. The trial court deemed 
it proper to allow the plaintiff to show a neck in 
normal condition btu refused to allow the same 
nrivikfe to the defendant. The plaintiff was al- 
lowed to introduce teatimooy to show, by means of 
the roentgen ray and the skeleton, proof of his 
injuries, and the reviewing court held tnat the same 
opportunities should have been given to the de- 
feiidant to test the correctness of the »«pi«»ft^*i«^ 
given by Doctor Brady. ' J. A. Cosraowpm. 

Emplojrmcnc by Corporation. H«i. lUc.. 1916. 

Uxxix, lOQi. 

In II I N. E., Page 16, the Court discusses an ap> 
peal of a case in which a physician, called bv the 
manager of a corporation to treat an injured em- 
ployee, sued the corporation for his fee for services 
rendered. The testimonv disclosed that there were 
no objections interposed by any of the directors 
of the defendant corporation to the employment of 
the physician. The Court held that there was a 
ratification by the companv of the manager's orig- 
inal contract with the physician, and that the 
corporation was liable for the doctor bill for a enri cea 
rendered. J. .K. CMStJuamea. 



GYNECOLOGY 



W.S.I 



5vt..GfMC>. ^O^iL, 1916, ott, Mft 



telhaUl 



of tba all 



tW f«ct thai tht dfcyntw oi cancer 
CM ftoi be made eitfiiv dfaUcaDy or 
Mifl a diiitu dtnirtive capacity b 
kmm attaaolt to apiiM the evola- 
lioMffy ckanctar « tW oMMe by the appUcatioo of 
tbe term **iNoeaac«oaa** to tboee chaafM wbidi 
a vanable qoaatlty aad quality of the other 



hieiolintril critma of caacor. 

la a stody of the tttarataie aad soom uteriae 
awterial vhkh he hat boea able to collect, aomerow 
BMiphoiodcal ahovatiom of epithelial growth have 
bew foaad which dUhr but little from the rcfaaera- 
thre activby of baalfa Iwtoai, bat which after a 
loafer or thoctcr tiflw show faatofca that are difleren- 
tktad with diAarily fnai the alttratloM which are 
haawa to typiiy aia%aaat aaoolanM. TIm itroag- 
«t aapport for thii aManptloa li fooad in the repro- 
dactioa of tvpea which are eeea ia the different 
tumm of thcv prngtMi The atypical feattiret of a 
haalbc erorioa are foaad to be dcterarfaed by the 
otigiaal type of the primary erotioo — riaiple, aapil- 
laiy. follicular; and the atypical typca are acua re- 
p to da c a d ia the different types of fully cetahHahed 



la the aathor'i catea, there were atypical healinf 
e ww i u ae which are prototypca of cither aa cpider- 
aoid caaccr or a papillary adcaocardaoma. There 
ware leafoplariii which are prototjrpcs of adult 
acaathooMta. There were alaadular hyperplaaiaa 
which lead to adeaoam or aneaocarciaoBUL Flaal* 
ly there ware focal areaa of leacoplacia« romMiiwl 
with adeaooMtoas hypcrplaaia, wfiich aeay faraiih 
aa oftgia lor taaMn dee^paied aa aifaao araathn 
11 a la ihon, for each type of fo^y devilopo d 
cardaoaw there ia a cocreiiMMag type of bemga 
aad iatenaoifianr chaaga. 

The aeed of aoee fiMr pfT i itifa beiwaea the cila> 
idaa aad ^ ^"^"^ ^ ia eaqiharfaod la ordv to < 
tea or dM^UwlStalpaatic relatioat of the I 
of bcaiiBMoaeaadcaaoir. It Ja ao aigiimeat. for 
the piHMts aiaiait the aMMptioa of iacwfleeinaiy 
' taaMr aroceM piaMaia ar ioBowa 
The ewdeaca a the Mtarataia la 
to ahow that a falhr enabWihad 
' .p waaHde acejrfitt 
i are recorded ia which 
the carettt haa cea^detity reaiowd the 
Kehher ia ihare reiaoa la aMuae that arecaaoeroaa 
withoat tnaUBMM alwajra oevelop iato 
growtha. MfHaac types of fally eetab- 




liihed tumon grow aad dcairav rapidly or eiowly, 
aad It does aot eeem reoaoaahle to aaaaM that a 
Hevelopiac caaoer haa the Muae laoaieatiini that a 
(ully eUawlihed taaior poeaceeeib Pkom a prM- 
ticd naadpoiat. the author beHevea that the prapar 
thcfapeoiic procedure io theee caeea ehoaM be decer- 
mlaea by a coa^eteat diaidaa. 

■aaeehnW.J. 

■Mat of Ucerlae 
1916, hdv, 998. 

The paper b baied apoa a review of the literature 
aad a report of »$ caeca of caacer of the oterae 
treated by radium. Of the as caeet in the aathora* 
eetice 11 are »iill well. Of theee, 3 have been well 
for two yean, 6 from one to two vcan, aad a from 
six months to one year. Of toe 11 cliakal r»> 
coverics there were j op er abl e and S inoperable 
caeca. Of the 3 operable caeca oae b well after two 
yean and a over one year. 

The authore state that In t hdr experience ( here has 
not been a sii^ case of uterine cancer that has 
not been more or lem benefited by radiation. In- 
variably there was ceeeetion of the bleeding aad fool 
dischaigea aad nala waa greatly or eatirehr nlieved. 

Their coadonoas are summed up aa follows: 

I. Radium b the method of choice in the treat- 
ment of inoperable and borderline casta. 

a. Of the three operable caaes treated with ladfam 
a clinical cure has oeea effected in each case. 

3. Caaca clinically cured by radium shoaki aot 
be subjected to hysterectomy, as the op er atioa b 
difficult and dangooos. iUavKv B. llAmmwa. 



Boldl. II. J.: Illab Heal Vetaus Low lieoi la the 
Traacasoat oTCaaoer of the Uiarwa. Smt 
Gymtc 9t 0^., 1916. ssli, alS. 

BoMt iiptemiid hlmadf faOy oa the relative 
valae of hij^ degreee of heat coaqiared with law 
degrecaof heat as a paUatlva therapaatic ageat ia 
theadvaaced stages of caaoer of the atcrua, ia aa 
article pwbMshad ia Jaaoary, 1916, aad iadgbig ffoai 
the ooauaaaicatioas that he haa recdved IvBM phyd- 
daas who have had eaperiears with the ireataMat, 
he bdievea hb poddea waa amply iaediad. Oa 
kypothceb waa also c orrobor a ted by aaocher 
aatopnr, la addltioa to the oae that he had, by 
DrTW. Baacmft of New YoriL 

He doea aot wish to be uaderetood aa detractlag 
fraai the aedalaeM of low heatj bat bdbvea thatb 
shoaM be leeeived pdadpalhr far a eecaad ai 
tloo. after rapid deenwctwa haa bee 
with hiiih heat, aad the chaffed eschar that 



61 



GYNECOLOGY 



63 



canted by the high beat bat been tbrown off; and 
(or tbote catca in wbicb the caaoer hat to far ad« 
vanced that the proper tppHcatfam of high heat 
woold endaofer the bladder or rectum. 

He coatondt that the danfrr from tecondarv 
hjrmorrhage b not less with low heat than with 
high heat, and that no cWdcncc has been presented 
•bowing the toperiority of one method over t he oi her. 

He state* tut heat properhr nted and applied in 
correctly telacted caaea tonetJmes givca remarkably 
foodpauathmeffecta. Bat it hat been coodiMivdy 
ioown that caiioer<ent are not destroyed any ap- 
pndable dittaace from the torface of appUcatioo, 
certainly not deeper with low beat than with high 
beat. TUi wat proved by the examination of tis- 
tuet procured at the autopeiet mentkoed. 

Dr. Charles Mavo. when ditcnariag the paper 
aOoded to. aaeerted that the proof of the deep de- 
struction of low beat as shown in cases that had been 
operated upon in the Mayo clinic, lay in the fact 
toat at the time of cauterization the disease was 
too far advanced for the patients to be operated upon 
radically, but later the uterus became mobile and was 
estirpateid, and when these uteri were examined 
by the p athologist, he failed to End any evidence of 
malignant disoise in them. This hypothesis is not 
accepted by Boldt as valid proof, since the mobility 
may have become impeded by an inflammatory 
process, which, as the result of the heat treatment, 
became dried out as it were, and mobility of the 
utemt resulted; a result seen also when high heat 
is used. The inflammatory infiltration may sub- 
side, but the carcinomatous infiltration remains. 
To disprove this it b necessary for the operator, 
when tne abdomen has been opened, to remove a 
part of the tu^Mdous infiltrated area in the pelvb, 
a reasonable distance away from the cervix, and 
have it examined by a competent pathologbt. If 
that shows cancer-nests, and the uterus becomes 
mobile subsequently, so that a radical operation 
may be done, and the specimen then removed by a 
radical operation faiU to show cancer elements in the 
l>.irametria, then it would be plausible to grant the 
• Iccp destruction of cancer elements by the heat ap- 
plied, but not until such proof has been shown. 

.\ttcntion b called to those instances in which 
recover)' followed when a simple extirpation of the 
uteriis had been done, despite some parametrial 
infiltration, and in which, after a period of a few 
months a re-examination failed to show any ev- 
idence of infiltration. The author describes two 
such 



Mandalre: Goncrlbutloa to tbo Study of Utsrino 
M Do* to Abortloa (Ccotribtttioo A 
! des gangrenes ut^rincs abortives). Anm, it 
gy»«€, d W*«M., 1916. xlii. 19J. 

The author's short contribution deab principally 
with uterine gangrene resulting from perforation 
caused by instrumental abortive procedures. He 
divides uterine gangrene into three categories ac- 
cording to the ctiok^: 



I. Uterine cangKae due to metritk _ 

infection and oevdoping without either traumatism 
or caustic injection into the uterus. Thb form of 
nacrene occurs without any attempt at abortion 
but it b very rare. 

s. Uterine gangrene due to gaacrenotts fwftnfffn 
and occurring in the nei^boroood of a tnuunatic 
contusion or perforation, the form commonly aMC 
with. 

3. Uterine gangrene due to canstk lajectlont: 
thb type not usually occurring with Instnunental 
perforation. Maudaire auotes a few illustrative 
cases and shows that whetner there b actual instru- 
mental perforation or not the risk of a gaapoMMa 
perforation being communicated from the ntenis to 
the peritoneal cavity caUs for intervention. Al- 
though the conditions for intervention are generally 
very bad, nevertheless he thinks that it b the only 
chance of safety for the pAtient. W. A. BaamtAM. 



Beckman. V. B. : Two Gases of Ucerloe Perforadoo 
with iMue of ForaltBBodlso Into tbo Abdomin- 
al Cavity (Deux cas de perforation de Tuterus avcc 
issue de corps Atangers dans la c^viU abdoauaale). 
Amm. 44 gyn4e, tt €tha., 1916, xlii, 306. 

Both cases reported by Beckman had reference to 
attempts at abortion, but in one of these no actual 
pregnancy exbted. Neugebauer has collected 15 
cases in which attempts at abortion were made for 
a suspect ed pregnancy which did not exUt . Of these 
15 women, 5 died and in 4 of these foreign hnrtlfi 
were found in the abdominal cavity. Neafebnaar 
thinks that abortive maneuvers in the ahtcao of 
pregnancy are more frequent than b »*»*«"^gMi 
Bediman points out that recently several sacfa cases 
have been reported, and states that there are bow 
46 cases in the literature. 

Diagnosb of the presence of a foreign body in 
the abdominal cavity b often difl&cult and the 
symptoms arising from such may easOy be confound- 
cd with other conditions, particularly where the 
patient, as b often the case, will not nuke an avowal 
or b ignorant of the circumstance. But if the 
/fffgtwJ« is made it b necessary to operate imme- 
diatdy. The abdominal incision b hot becanse it 
not only permits the foreign body to be removed, bot 
it also shows whether the intestine b perforated or 
simply scarified. 

Regarding removal of the uterus, the author doss 
not believe in the dictum of Schauta that thb oraan 
must be removed when there b fear of infectioa. 
When the intestine has been perforated, but tbMi 
are no signs of infection evident, then iotent-entka 
should be limite<i to the removal of the foreign body 
and suture of the perforation. When thore is a 
foreign body in the abdomen and at tka aama lima 
in c o mp l e te abortion, hgrn on h age wiD aeoa 
fftmrit**^ of the abortion. Tne study of 
in tne literature, however, shows that wl 



diagnosb of thb kind 
can be deferred. 



where a 
has been made iatanraaiioa 

U.S. 



INTKRNATIONAL ABSTRACT OK StRGKRY 



lluirlilM.II.T.t TiMRMvat 
J.Am. M. An 



U 



Had 




lOlA. Itvtt. 940. 

TW im ef iIm amkor^t lavwUniioM war* car* 
id oM la Mft aAci tad diak. la tvary paticat 
^■»i— I «^ caa^iaiMaf Nff n t tf t and ia^ o( 
Mppoit a caiafal aota b nuda aa to tba paritiaa of 
ih» utciaa, aft a wbola, la tha pthrfe. TIm lala- 
livr poiitioa of tba candi 10 tba ■yaip b j f i ii pobii 
aad tbe iicbial tabwa il li M b im aoiod. no attaa- 
tioa vbaiavar bdaf paid to tbe fonraia or back- 
waid poAioa al taa faadai. Tba rr- — * iba 

tba aaMaat of poiiarior dwciiin of tbc crr»^x. In 
iptokiilt of diMHt, tba aalbor aMoai oaly tbe 
pOMarierdMMBt toward tbe coccyx aad la ao way 
tba roiailaa witb d«eHt towaid tbe ootlet, a coa- 
dkioa wblcb fonaa aa eatifoly difaiaat da* of 
Tbe etabOhy of tbe lowar part of tba broad 
tba pa i acanrkal timiat, aad tbe utero- 
aeato are taitad by pMping the utenis 
tba *■—*■*■§ baadi aad aMmac it as far 
aa pooMa ap bdMid tba aya y byb aad backward 
toward tba coccyx. By tbb aMa a a foi frequently 
ibaacbaaad dcaf,of wbicb tba patfaat conipUiaa. 
caa ba if p r ada cad t<Mpnrirfly. TVa b alwaya 
a derinbla fMtHa ia aay dhgaoatk wofit la wbkb 
paia b a qraplflak 

PRMa tba anariaatloa of a lame icffka of caaca tbe 
aaMaat of poilarior daiceat b fooad to vary coo- 
iidarably. Tbe aatbor tbea plaoea taamooa la aucb 
a poaiiioa tbat tbe atcroa aa a wbole, aao Boc simply 
tbe fuadna, b forced wcO forward, op back of the 
synphysb in tbe poaitioa wbere a Um iOHwmion 
will bold it. Tbcae tampoaa are aOowod to re- 
awia for foitjr-cigbt boonu darias wbkb time the 
paiicai b faMiactad to aecp aboat ber normal 
acttvittc». walUaf. daadaL or wbatavar iba pleaaea. 
At the rod of forty-aUbt aoars tba patkat raporu 
tbe reenh of tbb ixptiiBiat If tbe backacba aad 
drag have baca veBavad, tba author faab aara that 
aansaaiaa will dva peraMaeat raHaf. If tbe 
fc^A***" b aot idkvad. tbca aowM otber caaie for 
tba aaaM aaaat be aoagbt, a caaaa oataida of tbe 
poaUoaoftbaataraalatbapahrfa. BytbbaMaaa, 
■aaqr caiaa of aarm Bar pala aad back itrala are 
daaqy ilJiiiaalbUid from low pafai dae to atarlae 



Aa a laaah of bb stadba, Hatcbfav baa been led 

to mmsmA aauor aaiiiMiBad aieri la wbkb be found 

lakd hif the rlaariral symp- 

aad wiib aaoaBaat raanlta. 

Bawaaa LCoamu. 



toaw of a letropOHttoa^ 



AfMMWAt Ain> pnuuTSRiirB coifDinoiis 

Phmtaa. W. Dit Ovartaa Tnuwpkaiailoo; Report 
off Caooo. TtmiSi J. Mti; t«t6. t». i\y 

Tbe autbor reports la cases of ovarian traaa* 

aB of tba aatoplasiic type. Tbb 

idataafroaiOaceaber. 1914. and up to 

lae nnacai ilaw tbe fc 



tkaad: In oahr oae of tbe 1 1 cases was the uteraa 
raawvadi la ihbcaae ao fait bar nport waaoblaiaad. 
Of tbe reaialninc 1 1 caaaa. 6 are aMaatraatlaf nn- 
Utfly evary amib aad wltboat pala. Tba aataor 
maailnai that tbe paiaailoa of pala waa vrnr aotka* 
a la tbaaa caaaa wbkb bad rrtamed before ova- 
I traamkatatloa for a aaooad laparotoaur bocama 
pala. Fkoei tba wimilalai \ caaaa tbe poat> 
iratlve bbtoiy waa aaobtauuiok. In j of iba 



abk la tbaaa 

riaati 

of 

opmtl% 

above caaaa tba' graft waa active aad functioaiac 

two yaan after oparatioa. 

In tbb aoriaa of caaaa tbe foOowiat tacbalqoe waa 
used. After reasoviac tbe ovarka taey ware plaood 
In normal aaUae idutloo at a teameratore w 100* 
and the operatko completed. After ckaiag tbe 
peritoneum, lectloaa were aiade of tbe moat deaurabk 
part kA the ovary. Tba aiae of tbe graft vackd 
from one-quarter of a normal ovary to a section oaa* 
sixtrrnth to oae-ekbth of aa Inch In tbifkaia a 
The abdominal wall Just to tbe side of tbe nsadlaa 
indaka was the tite selected aa tbe moat favoiabk 
for pUdnc the transpUnt. making a pocket Jost to 
the aide of tbe median line in tbe *^mim tbio^ or 
underneath the rectus musck. Tae immediate 
poatopemtive history of tbeae caaea hardly differed 
from the average case. In some of ibem tbe (paft 
became tender and swollen, but In none of tbe cases 
did tbe graft become infected or ilnnaMiialiiii In 

appeared between lh« second and fifth month alter 
operation. 

In coodttsioo, tbe autbor aajrt that be b fully 
convinced that these caaca were hcnefhed by the 
ovarian tranwilantation; and that ita 
Itabie 



oae in suitable caaea would not only dimlabb tbe 
caaca of p fwi p l^ mfd awaopaoae but woald leoMa 
tbe iacBcraoaa for aacoad aad evea third bparoto* 
mka. Tbe ovarian transplant performs its normal 
faactioa of ovulation, and wQl continue to do so in 
the average caae for a number of years. Evea at 
the end of tbb time should the tramplaat caaaa to 
function, it will at kaat have served a part of iu 
duty. The artificial mfnop a a a e will be laaa abrupt 
aad tbe symptooM dlnrinhh aa the patkat baa 
opportunity to adjust banelf to ber new coadhka 

W. D. Paiujra. 



MnCBLLARBOUS 



p. J.t 



TIjpiiBUb 

1916. axn, 174- 



to 



KfllaOoa to 
50rf. 

Tbe rare Biaatioa of tbbqraiplom in 
cal literature b oot of proportka to tba < 
f reoueacy of Ita occaireaoe. A poaitiva dkoada of 
aypUitk fever caa oaly xw4^ ba aiada. aat tba 
dttMaaab r*** ba Bade witb raaaoaabk canalaty la 
cewaia graapa of caaaa. 

Tba aatbor dhrldaa qrphHltk fevtr lata tbe lolaw* 
iaggroapa; 

t. Scooadary aypbOltk fevar occvrring at tbe 
oatbreak of tbe eraptka, katiag aaaaffy oaly tbraa 



GYNECOUXiV 



to four (Uyt with a riie ol temperature to qq-s 
or too degneft. Fooraier wtimaiw that the 
flympcom oocun is ao per cent of all qrphlBtka. 

a. Late teooodary typUUtk fever majr oonpU- 
cate nregBaaqr or gvaecolaglcal ooodilioM; it b 
wwiily proloogd with a higher degwo of tesipera- 
tme. The aolhor dtet several catea, ooe of which 
had hecB diignniwl at typhoid. In theee caeca the 
diagnwiit waa baiad npoo the podtive Ustorv and 
evideacc of a tjrphilitk: infection, the ndwioa of 
other febrile diseucs. and the immrdiate and per- 
manent results of antisyphiUtic treatment. 

y. Tertiary syphilitic fever b of greater diagnoa- 
tic importance tnan the two prevMoa group** b^ 
cante the symotoms and history of ^phuis are 
often absent and only the 4 plus Wassermann points 
the way to an interpretation of the continuous fever. 
Eighty- three cases of tertiary syphilitic fever occur- 
ring in t he literature are analyxca, including one case 
in the author's experience in which pelvic gummata 
were responsible for the fever. 

The cause of syphilitic fever is in all likeh'hood 
to be found in the entrance of spiroduete-tozins in 
addition to the organisms themselves into the drcu- 
latioo. Probably individual ptedisposition b also 
an important factor in the rise of temperature. 
The fever occurring occasionally after injections of 
mercury or salvarsan when it may be fairly assumed 
that large quantities of endotoxins are liberated 
from the dnd spirochete, u additional confirma- 
tioo of the intetpcetation of syphilitic fever as a 
toxsmia. 

INckinaon. R. L. : Simple Strrilization of Women by 
Cautery Stricture at the Intra-uterine Tubal 
Opaaliiia* Compared with Other Methods. 
Smrt.,Cynf<. irObst., 1916, xxiii, >oj. 

The anthor goes into detail conce r ning all meth- 
ods, sn^ aa the loop-holea of danger in each one of 
tlK coo tracep tive measures; the gen«»ral refusal of 
the husband to have the vas deferens tied or cut ; the 
lightness of the claim that it b the female who b the 
ooe of the pair reqtiirinc safeguarding; the uncer- 
tainties of the X-ray. lie believes one b not justi- 
fted in opening the abdomen for thb puroose alone. 
The risk to life — however small — b to women 
who are poor subiects for operation. The nervous 
sCicas, the pain, the weeks or months of disability, 



and the chance of the drag of adhesions may not be 
tightly ragarded. The only outlook for a sfaaola 
and sure nathod. and that without danaer or mmtt- 
ing or loss of time, seems to be thiou^ dosvre of 
the tube where it enters the uterus by a stricture 
produced as the result of a bum with the fine-tipped 
cautery elearode, a nrocedure aiflsple enough to be 
done in the office or dJsiwinaif y. Stvco to tea d^rs 
following a period, uaocr iaCmHttoriao novocaiae- 
adrenalin anesthesia, the sixe and shape of the 
upper angles of the uterine cavity are carefully 
measured by the ordinary uterine mnumL Tbea n 
special sound tipped with a tiny bluM p l atin u m col. 
or a round-end fine naaal cautery electrode b passed 
to thb ascertained depth, into the tubal entrance, 
and suflkient heat b applied to produce a tk/o^ 
The circular scar of thb injury contracts and com- 
plete closure results. The amount of heat and 
time required and the p r ogr ess of contraction are 
checked up by means of a preliminary control-bttm 
on the face of the cervix. To test whether perfect 
atresia always occurs will call for further study of 
tubal catheterization, and X-ray tubal shadows, and 
tubal distension tests. So easy a maneuver where- 
with to sterilize idiots and other defectives merits 
extensive trial. 



PIccardo, T.: Ilyperofaria In the Bdopni 
of Uterine Myoma (La hiperovaria < 
genia dd nuoou uteriao). Prtms* wtH.^ Afgcat., 
I9i6,tii,87- 



BpnthogaDssIa 
> ca la etiopaio- 
m4K., Afgcat., 



Piccardo thinks that there U a relation of 
and effect between fibromatous uterus and d M eren t 
adnezal Icaloos, such as hypertrophy of the ovary, 
enlaigement of the tubes, etc 

Myomata are tumors composed of smooth nraa- 
cular fiber. The hypeiplaaia of the fibers of myoom 
b analagous to that wnich b produced in the first 
oKMiths of pregnancy, during which time there b 
ovarian hyperfunction. 

Abo during the preluemorrhagic period of men- 
struation modifications analagous to nqroom are 
produced in the uterus. Taking these into account. 
as well as the uterine atrophv after ocHatiOB of 
uterine function, the author thinks it ouftcically 
established that there b a relation of cause and ofhct 
between ovarian disturbance and myonuuoos hgrper- 
plasia. W. A. 



OBSTETRICS 



FKIOIIAJICT AMD ITS COMPUCAnORt 

of 
the 

giMcdaiN TW •mbor had a wircwrfiil one to 
Ml pradlot Mid iJHrai Um iwlts of hit towtisitloM 



•.I 
yofrn.. 1916. uiii. lit. 

Aa tctivdy grovtof ■hdonrinol 
rit ■omIm* donlloB b rut to Um 



of the 
leaa- 



of iWnbiKt. 

Bovliit Ml dovB tbo pOMiblt 
coadhloa Iw •bows thot whOt " 
tog to ■iwiyiHwrtion. ftpori i imm kovo 
tiniitd tlMt » l ¥faoc U oo te wA Mwonrfnl to provtog 
<Uu M 10 iMominol prapMDqr. 

He dvdb OB Um atVHM dUBculty in dtignnoh 
•ad idon ^T*^^"r ^ tkb difficulty to hb CMe. 
Tbe foOoortaf mo dJipworif potou: (1) marked 
•OMkivnMai; (t) tlwia are ao totenahtcat coatrac- 
tJaat; (t) iffTegalar oatHae; (4) the child is directly 
tat tUa; (s) tbe hean-eooadt are directly 
the tar; aad (6) the fact that retrovenioo b a 



Haviaf dtacaittd tht vaiioot iafaaticidal BMthodt 
vkich have btta MMpHlod tht tsrthw ccmliMbt that 
Itparatoanr b tht oily fona of tiattmtat Regard- 
faif opetatina ht btntvtt that tht pboeata thoald 
alwasrv be ruaovodt VMttb bctog riiwiptd aad lint* 
edanheyareeaooaattnd. SpttdbtMMtiaL Hb 



the caceptioa 



R.t 



I pobrlfti dariag oprrttioa, bat with 
of a lUght attack of cyititb during 
oiade aa oaeveatf ol r e c of tf y. 



ofictoplcl 
PaBTIma. GU$t0m, 



Whkhltod 
./., I9l6,iv. 



Tht 



•t nported b of a wooMaaitd jo, a I'part, 
adanitd to the Glaagow Royal Materaity 
1^ Bctpital. November it, 191a. Three 
at fall ttftiu labor caaie 00 but 
CDataioa of what was taid to 
hava btta a pitot of plaotsiat thoagk tht patitat 
■liMaiMd that tht i& Ml aowMMal 




Shthtd 

II Jaaaary ioattatiMk bal March 

had had ttvna ahdaaiaal pato aad 

a bloody Ttgh Md dbjE hMgfc AprM l a yi -tol iht 

dt of tdopfc pwpiary wia awdt u that 
ttoM. Tht piigaafy lad rnattoatil whh very 



at tht tiaM 
tht top of tht tvaMT dott ap 
Tht foMal paitt coold at 
palpaitd, Uit htad bdag lA Ugh apw Thtrawavt 
aolstalhtait-tondfe aad aa i(p» of lit. thai«h 



of 
to tht 



tht patieat stated that iht ftit mn»ianali oa the 
day of idmlailnn. Tht aoo-pngaaat altrat wa* 
taurfBd, pothtd over 10 tht wTt tidt, tad the 
otrvical ctaal would thea tdadt oat iaigv. The 
uttrtot cavity was empty. Tht cooAloa wat ^Hag- 
aoitd aa an enra-utenat gartitloa beyoad fob 
Itrm aad with a dtad fosttia. 

The patieat was oot r attd apoa to NnMialii. 
through a ceatral iadsioa. Oaly tht oator layor of 
the fortal sac was opened. By totrodaciag tht haad 
between the sac wall aad the amnioa these toytn 
were complttdy separated with oaly a small 
amouat of resittaaoe at the lower part where the 
plaoeata lay. Tht nlactata itadf which lay ia the 
lower part of the abdomca was easily lifted out with 
no bkediDt from the site. 

Aa much of the sac was rea wved as could be 
doat taaOy. but the greater part of it had to be left. 
Tht abdooicn was packed well with iodoform 
gauae aad tht wooad partially dosed. Tht ooa« 
valtiwnce waa aatattnapttd but the scar wat wtak 
n lm tht draiaagi had btta. 

Oa rradmiitlon ci^ moaths later, for heraia, at 
the site of the draiiuun tear, it was fooad that all 
trace of tht sac had dnappeaied aad thaia were ao 
adhesions eaoept that tae pondi of DoMla* vas 
partially oblittrated. C D. Bouoa. 

Murray. G. M.i Tho Aapttcation of 
Proctodyala to the TVaataseaf of 

S^mtk, If. J., 1916. ix, 899. 

Murray states that aatcpartum and partvieat 
ivpca of tdampaia should m made postpartum by 
tat appropriate method of defivtry. If the pttital 
b c oMck wi from 60 to 90 can. of castor oil b givta, 
aad the dose should be repeated freely throaghout tht 
rsst of tht treatmtat aad coavalescaact. If tht 
patitat b a ac o B t c i mii , oat to thret dropa of crotoa 
ofl to a blaad dfy OMdiam b adadataltrad by tht 
stomach tubt if atcamanr. Piaotdtoc or fpOowtoc 
tht preparatory catharris tht bowtl i art osovad 
with Ugh tatmsia twtH a dtar rttoia flow b ob- 



Tht foot of the bed b thea titvatod ftva to tight 
Tht patltai b pal to a hot wti pack aad 



id fnqpMBUy to piavHt hypo- 
Kaa^^ rttam warn mcui iniga- 
attHat aad toitrtad tolo tht rto- 



her potkloa 
static ooalgti 
tor b ooatad with 
torn as far aa poaiihit aad ba oattr tad covtrad with 
ceuoa to prevtat tht volva aad aoft parts from coo- 
tact with k. Tht itttiyolt b titvatod two or three 
foot abova tht Itvtl of tht rtctam aad thtoalAow 
tablM b ltd tolo a tab at tht btdildt, kt loaar 
aad aiwaya batog far taoagh abova tht walar to tht 



M 



OBSTETRICS 



tub lo that the boiw cu aaontain it the irrigator b 
workinc by the toand of falHag wmter. 

Nonnal or dedoomial mUm solution at a tem- 
perature of from 105 to 1 3o* F^ at a rate of 18 to ao 
rnt per hour, ia osed in the >^«^"*ng After 
nriiury function ia re-catabUahed tap water b 
onplojrcd. If ce<lenu of the longi odMa Murray 
bcpna with tap water and doea not pmh the irriga- 
tion. The irrigation b moaUy connnned oninter- 
rapted for from m to 72 boon, ahhongh ocrarional 
fcat periods, without irrigatioQ, are permitted to 
avoia maceration of the rectal mucous membrane 
due to the prcaence of the tube and diatcntion of the 
rectum. After a relatively dear flow b obtained 
throui^ the outlet tube, the inlet b damped so that 
a rate of supply of from j to $ dropa per second b 
maintained. F. C. lavmo. 

Wnaoii.W.T.: Lumbar Puncture for Rattaf of Con- 
vuMoaa In Puerperal Frhimpehi J. Am. M. 
Au., 1916, Uvii. 74a. 

The author reports two cases in which lumbar 
ponaure mcccaaiullv controlled convulaiona. The 
mat caae was that of a mulatto, aged 35, who had a 
blood-preaaure of 355. After the patient had had 
her twentv-thirdcon>nUsion, 40 ccm. of spinal fluid 
was withdrawn. Before the spinal puncture the 
patient waa in coma. On removing the needle, con- 
adoMoeaa immediately returned. She had no more 
oottTobiooa and in three da>*s the urine was free 
fnmi albumin. 

The second case was that of a white woman, aged 
Ji, who had had ei^t convulsions before ddivery 
•ad twdve following. Cerebral excitement waa 
•evere. .\fter the withdrawal of 45 ccm. of dear 
fluid by lumbar puncture the patient at once 
became quiet and had no further conviilsions. The 
oiine output increased remarkably and she made 
an uneventful recovery. 

The high mortality in eclampsia u no argument 
againat the aaefulneia of the treatment in proper 
caaea. Lnmbar puncture is a treatment which 
■boold be used only for the convulsions of eclampsia, 
■ot the toutmia of pregnancv. It does not take 
the place of the other forms of treatment. 

EowAan L. Cokkbu. 



k 



H. D.: PIniitrtn In Poatnbortioa Curette- 
mcnt. Smeg.,Gym*(. (rObil., igiO, txiii. 36$. 

Bniisa has for the past year made a practice of 

I ccm. of pituitary extract hypodermatically 

curetting for incomplete abortion. 

The advantagea of this procedure are that it 

firm itterine contraction, wUdi makea the 

eaaier and almost Mnnrllcw BecaoM 

contraction the cavity b smaller and the firm 

offered makea the operation more effective 

he bdievea Icaaena the ri^ of perforation. 

le has found fifteen minntca before curetting to 

the most favorable time to give the pituitrin. 

[When the interval between adtointstraiion and 



operation has been Icaa the result haa not been so 
satlifactory. . 

As yet he has seen no poatoperative hcmorrhafa, 
bat to be on the safe aide and guard aninat it, he 
has packed the utema and vagina with iodoform 
gatue for twenty-four hours. 

With the use of pituitrin the blood lorn b so 
much leas and the curettemeot so much eaaier and 
more satisfactory that he strongly advocatca ita 
general use. 



Doljnii. C: Pregnancy nnd Arterial Ti 

(GroMeuae et tcMion artMdle). Arck. 4* mtl. 
r, 1916, is. 3S8. 



The author has studied the modifications of the 
circulation during pregnancy, labor, and the poer- 
perium. The present report on arterial teanoo b 
a preliminary one and will be suppleme n ted later. 
The sphjrginometric oscillometry of Pachoa haa 
been em^oyed in thb research in the ofaatetskal 
clinic of Bucharest. 

The author draws attention to the following 
reaults: 

I. To a hypotetision. both maximum and min- 
imum, during all the duration of pregnancy. 

3. To a hypertension, both maximum and 
minimum, during labor or during the oontractiooa 
in abortion. 

3. To a hypotension, both maximum and mini- 
mum, during the postpartum period. 

4. To the hypotension, maximum and minimnm, 
of pregnant nephrites. 

The reduction of maximum and minimnm valnea 
b manifested from the first months of pccgaancy 
and b often considerable. Minima of St 4, ukI \ 
and maxima of 8 cm. Hg. have been regbtered. 
Except in pregnancy the author has never met with 
such reductions. 

This h>'poten5ion of pregnancy scema to have no 
relation to the volume of the uterua becaine it 
may be met with even in a praooonoed degree ia 
the first months of aestation. 

During labor and capedally during uterine 
tractions there b a rise of the maximum and 
mum valuea which b often verv considerable. 

After ddivery there b a fall in arterial teaaioa 
until it reaches almost to the levd of that before 
delivery; it then tends to seek the normal slowly, 
which may take weeks or even months to acooaa- 
plish. W. A. Bawwtsw 

LABOR AlfD ITS COMPUCAXIOltS 

Davia, B. P.: OeUvory by Ahdomhml Sectleik BdL 
ifW.-OUr. Ftt, M4., 1916. is. jj. 

The author poiau out the daager of an occa- 
aional pdvic ibeceai complicating pregaaacy, which 
if discovered ini|^ laiBcate that tlie labor might be 
very much better managed by abdominal sectioa 
than bv any attempts at normal d e U feiy. Appea- 
ia in pregnancy offers another risk to the I 



if labor ia allowed' to set in. 



rpaticat 
The coattactioaa vffl 



68 



INTERNATIONAL ABSTRACT OF St'RGERY 



nipittft iIm wal of Um itenM with a twhlig 
pvfiioaiik. B«t m i lu fallow tlw ioomvoI of • 
ppoadii at vImiow tUm of pnf- 
it aajr occv. Tkt wwci oi pohrk or 
■on oohbHcoIhhi pioBMMQr it oIm 
OA kidkoilos lor toctioB* Bo odvMi oodooiiiool 
ii liko OMOI loiical tiootaoiiilorpioaMtitra 
of tlM plocoti, ■• «dl 00 lor octopic 
hk Um aaUwr^ iipw<Mico, ddlvory by 
is odampdo, Wwovor, it vary raialy ln> 



of Irft rcMilu with 
atfoHowa: 



tiMprfvit 



TkaaatlMMr 
Ha opar 



St 

laBtdlqra 



of lao e 
so M^mmtammm ia wlHch tba ti 
Md ika abdaoMB doatd without 

ia wUdi tiM ftump vat fa*- 
. > ia tlw lowar cod of Um abdooiiBal 
iacUoas J dtiipatloM of tba ntaraai aad t tactioot* 
pHioiaMd at tka aMMMl of OMtanal doath t 
total of »t6 ontfUiont. Tboie catat ouiy afaia be 
dividid iaio ijmm ibat vara ia fair condjljoo at tbe 
tiaw of ddiv'rr)' with ao fatal dJiratt of tbo vitoara 
aadapparrntlv uninfected byefpA,tnd tbote which 
were at the time of deUvenr infected or suffering 
from tooie fatal rtiieew affecting the important 
vitoera. Of the (onaar cattt ia good condition. 
ibtri ■< ri 1 51, withoaa laatCTBtldeath — a matcnuU 
aortality rate of 01066. Of thoee caaet that were 
iafected and in bad conditioa, there were 60. with 
i6dcatltt— -amofftality rate of »6 plus percent; the 
BMrtality of the eotiie icrica being 8 per cent. 

Tha oaa death aatoac thoaa ia good cooditioo 
o c a w o d from pcritooitit coated by the badllut 
ptoteut wlgarit. 

With the other fatal catcs the toscmia of prcc- 
aaacy ia iu varioot phatet waa the caate of death 
ia by far the greater aambcr of caaaa. DognMra- 
tivo coadjtioat of the heart matda, hidaay, aad 
Ivor wcia tha priacipal viaceral letloot ia thcte 
<aa«. At lagardt the fortus, there wms no foetal 
nawtaMty ia aay cate in whkh the fctttit wat ia 
good coadhioa at the Ubm of operation and thoae 
iort^ deal ha which occarred were the retolt of 
ar a fioa a attaa^iu at delivery, or iafection, or mal* 
loiatli<ia CD. Uouaa. 

Wlaaar, «.i Atanraiiil Labor. If. T. M. J., i«i6. 

Ia daolag with abaorsMl labor. Wiener advitea 
tha ate of lanrp b i a e ahorUy before delivery 
of tha daagar of aaicotlaiM tha chikL la 
■tcriaa iaartla, ah aio it It 
by aay of the 
atlondi, ha 
aoctloa lathar thaa the 
tha hu 




hirdioatatk b^ Dariag 
, ha tUaka that tha bag 
dtfla. which it oaly allow- 



b aMch prrfrrabla to pitaitila, waica it oaiy aiH 
able alter (oU dilafatina of tha carvfai at a aabatltau 



by aipactaaqr . Ha 
ia priaupafoat brtaca 
babaonaoL 

RafMdfaig plaotau piwria, h — o rthagt ia tha 
tiiBpltat Burpaal type auiy oftaa be malffollad by 
laptare of the laattibraaat, Shoold thit aot bo 
anftfiaal tha hydrottatic bag auy ha aa^rf^yed. 
Shoald tho bof faO to chadt tha haiiiiiirhtfi. bi- 
polar vanioa taoald ba doao aad tha aipifiba of 
tha child lafl to aataia, aa thanby tha ialaraitt of 
mother aad ddki art beat pnaarred. TMtOMChod 
la tha aiigwirift of privau pnctkt. 
pacUag balbfo dalivary b to be avoldad if 
at it pwidiaprwtt to iafoctioa. raatiaan 
tactloa b oftaa tha otathod of choice ia central 
ptoceau pntvia, atpadaOy in a primipara with an 
undilatad oandz. P. C lavom. 

■tfgar, J. Ct Paialwe Labor. J Am. M. Au., 1916, 
bvU, 7J9. 

The author't co o da tioat oa tha aabject are: 
I. Nitrooa oihlo-o atygea t n t lga a j t or **obatatric** 
other or ddoto f ona for the aoooad ataga of labor, 
pathed to angathraia (or the pariaaal ataga aad, 
pottibly, forrepe delivery with vapor aaaatharia to 
eliminate part of the lecoad stage b a — ''■ftfhn y 
procedara. 

a. Iforoover, aitfoat odda-oxygen analgfaia 
or anaathaaia b aapaiior to aay other during labor, 
bacaaae of ita oiytoak actioa. 

3. Eveataally aa aatabHahad mt^hiMl of polalaaa 
labor Biay ba coaaidered aoMMig pabBc health 
queatioaa. 

4. f eaaening or aboUahing the pain of labor may. 
in the future, limit birth control aad H«"*"«' 
abortion. 

$. Drug addict ioa after a proioagad drag aar- 
cosis in the a a ur opathic b a pcaaible MinllagiiiM ■ 

6. The daagers to the unborn or newly bora child 
are negligible when drug narcosis is linitad to 
tha firat atage of labor. EowAan L. Coaaati 

POBBPERIUM AND ITS COMPUCAnOllS 



lor low lorccpa. 

As bag ^ tha patbat b 
thor balavat 



the au* 
b bast treated 



8* H. : Piophylaib of Puerpetai Goaval* 
X. Am. J. Utmmp.^ 1916. nod, 961. 

The eatiaiatioa of the urea b the moat valuabb 
aad moat aimpb aaida wa have at preaeat ia fora- 
taOiag tha piababh oocarreaoe of coavabloaa. 

The eatiatatioa of the total aitrogaa b of vary 
litUe practical iasportaaoe. 

Tha aawaat of albwmia pwaaal ia the oriae b 
of aoooadary coaaidaratioa* 

CoavaWoat awy occur whore ap to tha tiaM of 
oocarreaoe there has beea oaly tbe alighteat trace 
of alba aria in tha uriaa. 

The blood-pnaaare b aot a rcliabk hidei at to 
the pr oba b b occarraaoa of coavnbioaa, * " '*^fp ^ nt a 
very mach huar ataga la the caae thaa tha arsa out- 
pat willahow. 

Where the urea b iarreoaiag below what tho 
aoraul output should be for that particular paUaat, 



OBSTETRICS 



69 



the removal from the diet ol meat ftod 6«h will 
tttually be followed by aa iacratie in the output ol 
am aad there wfll be lot probability of the occur- 
rence of coovuUona. 

The cUaical symptoms art of secondary import- 
in. • to the urea output In roretdltnK the probability 
i<! :).^ occurrence of convulsions. 

EOWAtO L. CoftXCtL. 

MISCSLLAinOUS 

WatociMld. A. J.: P«h4c tafacttoa. X. V. U. J.. 
1016. dv. 540. 

The protective resistance to pelvic infection 
depends on these factors: (i) the intcKriiy of the 
uterine epithelium; (j) Wrulencc and number of 
bacteria; (j) the Mtuation. site, ami their ability 
to grow; and (4) organii rt->Utantc. 

In broad ligament -i lie injury 

am! also bacteria a> Retained 

i ' ta, lacerated ccr\ii, and septic rntlunu-tritis 
art but sites of bacterial invasion through which 
the true germs enter the parametrial space, and 
the mode of entrance can only be through the 
muscular wall or contiguous tissue by way of the 
lymphatics or blood stream. In tlus way a throm- 
bophlebitic or hrmphangitic type of infection may 
be distinguished. 

The course of a typical parametritis can be 
summed up in the foUowing stages: (1) infected 
area hard to map out, but tender and painful; 
(i) oKlematottS soft mass at the edge of the uterus; 
Cj) exudate Increasing and spreading over the pcKns; 
(4) exudate filling the pelvis in the zones of infection 
with abdominal tenderness, rigidity, and uterine 
displacement; (5) temperature, pain, and tender- 
ness increasing to abscess formation, usually on 
the eighth to tenth day — leucocytosb of 12,000 or 
over caUs for surgical interference; (6) cessation of 
qrmpioms indicate resolution. 

Pel\'ic peritonitis or |Mrrimetritis t« usually due to 
dirty douches, instrummis or dI.i-.iIi otH-raiions. 
This condition i» s<' lis 

may result. Peritonu.^ :....;. ■.: ijus 

or a purulent cul-de-sac exudate, or an adherent 
adnexal mass. 



In the treatment of pelvic nnitonilla ouctta^r 
should be done oohr for bleeding or for saprvmia. 
in sapnenia the pclvia should be drained; in septi> 
caemia or parametritis the uterus is cxp lorwi and 
the pdvb drained. The author aevcr cwtttcs 
when the broad !»§■■»•■» or adBcn b iovohrcd. 
The diagnosis of tte coaditioa b Umm wwiitiil. 

W. P. Rkwitt. 

Bolcher, D. P.: K (,*hlld Wrlfhlnt Twrnty-tw 
Pounds at Birth. J Am U .In . t«i6, Uvii. 950. 

The mother was 35 3rears of age, 5 feet 7 inches in 
height; weighed no pounds; circumfcrcnoe at hips 
coiDchcs; multipara; delivered February la, 1916; 
had had eight normal children, including a twin birth. 
\\ birth these children had averaged from 7 to q 
pounds in weight. 

Vagiiud examination at 8 p.in. dmiag the im 
stage of labor showed left ocdpito-aatcrior prcacala> 
tion. The os was patuloos and permitted the in- 
troduaion of three fingers. The labor pains were 
of normaU freouency, but short, .\fter an hour the 
OS admitted four niagers and the pains were still 
short. The patient was given 5 minims of pitui- 
tary extract. The pains became move severe, but 
had little effect on the pasaage of the head. In 
two hours the 5 minim dose of pituitary extract was 
repeated; the paiiu then became strong. The oa 
was iwrmally dilating, but there was stiU slight 
progress of the head. .\t 2 a.iiL the patient racdvcd 
a third dose of pittutary extract of 1 5 miniasa. At 
3:30 a.m. the head was bom. The posterior 
shoulder was delivered with great difficulty. Much 
greater difficulty, however, was e x perienced in de- 
livering the anterior shoulder. It itq uir ed the 
comlnnetl efforu of three pjhwridaaa to deliver the 
remainder of the body. Tile child was a girl, 
weighing 25 pounds; it measured i» inches acroM 
the shoulders. 28 inches in length, and was per- 
fectlv formed. It was bom dead. On anatBatioo 
of the mother, the perineum was fomd dightly 
lacerated. This was completely repaired by thrrr 
sutures, under chloroform anesthesia. The patient 
made an une\'entful rec ov ery. 



GKNITO-URINARY SURCiKRY 



ADMIIAL, nDHBT, AHD mUtTtt 
ft.1 




Kcjr. ft.1 MiiMils mmi Wmttmi TVwombi of 
MaliaMM Tmmn of iIm Blimy (DImbow 
Md Opmitdn Mallpw MvwiwMrm). fr Xt 
Kmtk. Smt^ CMf ^ C wi ifco n . 1916. July. 

Of a6 caMt of sMlpMat tamoft of tbo UdMys * 
la tW otbor iS iM p k o rt o my 
OMt_potfa1 (Bid at the tfane of 
M, toMCtioo of tbt dU- 
■ad coOapw. Of the 
taaMn 17 von kgrponMnlaoaMto, oae o popiOorjr 
pMvic cofdaoaM vaka aod ipioad ovof tao catifo 
Mdai3f; » Iwd locanaaoM or died of met art trie or 
7 aie Ihriag oad arc frre fron rccur- 
faon three aMatha to three aad ooe-half 
after operatioa. It la aeoenary to make the 
cany. The rawHaal nranuaaa are hsm- 
pain, aad cipedally a palpable taaKtr which 
ia p r iam t in (rooi 60 to 70 per ccat of caica. The 
X«ffay frequently will abow a tvawr or aa enlarge- 
BMat of the kidney not palpahir Not iafrequently 
the patients die a thort time after the operation in 
coOaiMc. The author wmuli that thb laay be 
due to a qvaatity of adreaafin being throim into 
the circulatioa from the tamor at the time of the 
tMa hgrpolboria apoa obatrva- 
of the blood^MOMara talsHi aflcr the opera* 



Rovmo Bialanliii il that the ooUapec after the 
waa dae to the haimnnbafi and to the 
JWHMK. rapirially oa the left aide. A 
three to foar year oboervatioa tiaw doea aoc cadode 
oa. The food reeaha aa obtainnd by 
J — 90 per oeat care after a loaf period m 
oaairvatJoa -~ caa be obuaaed oanr by laiivlaf 
oat the correct tcchaiqae. The khney ahoald be 
maovtd im m» aa aa tafccted bum la the aumaer 
bgrftovriaf. 

that oat of j7 caaea he enlipa- 
todtkettBBOia'iaaT. Oaoopera U fo*' 




OaoUiidof the 

dfed of lacanMca. Oae livod for 

free froai l a cari e ace ; the majority, 



that the Grawiu 
laaMia taeie aoc hipwawhroinau bat cardaoamu 
of the hidaey. aa pie r hia i v brn af hl oat ia a leafthy 
aitidr. 

advlMd the rrrooval of a aoctloa for 
ia doablful rjur». even In 



la doaing the dwni— ion Ki v »(a(r>l that he in- 
leaded with hia aMtarial to thow how early recor- 
rrnre taket place. Re timnvai the kldaey aad, 
like Rov»ing. the coaaoctlvt tleaao aad daada 
alvo, whidi ia two of hia caaea wera oooaplctdy 
in%olved. Whether the Grawlta taoMr b a car- 
dnoau haa aa yet not been dedd e d. h. A. Jmanou 



A.i HMatMC^MaofftiM 

hidaticoa <W riaen). JfMwgraM 
1016. 

The author's ctt ea d re w oaof r aph oa hydati«i 
cyata of the kidnr>' is the result of a vonr coiaplete 
atady of the literature o( the subject combiaed with 
the author's penoaal eiqwrience with eight caaea. 

The author fatben nam the literature 47 caeca 
of hydatid cyat in whidi anhrectoaty haa bcca 
performed. Of tbcce, to died. 314 per ccat. Of 
19 operated opoa prior to 1900, the OMCtalty waa 
»6.s per ceet; of tae other tt ope r ated apoa dace, 
the mortality was reduced to 17J per cent. 

Comparing the resulta according to the method of 
approach, a6 cases were operated opoa traacprri* 
with 7 deaths, 96.9 per cent. Fiire of 
occurred prior to iqoo. Sevcatcca 
operated upon by the lumbar route 
with a roortahty of 1 1 .7 per cent. The aathor aaf • 
feata that in many of the cases in which deata 
occurred in operattoaa fav the lumbar roate latar- 
vcntioo waa coatra-iadkatcd. He abo bctfevaa 
that the doobu which edcted la the time of Boeckd 
and Houad aa to the valae of aephrectooty caa ao 
loafer prevail Whoa Mphractoonr b ladicatcd, 
that b, whea there b cemdaacy of the rcmainiaf 
kidney, it b a procedure with a rdativdy low 
nortalit! 

itidaacy of faactkaiaf of tha 
tha iifhtT nadftea tha iadica* 
tioaa for'acpkrcctoaqr ia hydatid UdiMy cyau aa 
foUowa: 

I. Ia cacaa ia wUch Uw total reaal 



aiortaiity. 

Graatttfthe a 
rwnafalBf kldaey^ 



aproaaied by tae aiiaiaaoa of aialtiple cyiia* 
». whea the rcaal tbaae b so 
that the qoaatity of pareachyau left b i a r a p aM e 
of falfilUag the function of urinary cHarfaalloa* 
either oa account of its state of atrophy or bacaaaa 
the anatomic conditioBa of the gUnd do aoi per- 
mit it. 

tuberraloda, cu., ooeibl with the cyk\ 

aot be eflcctively iwaovod by more coaaervative 



4. Whaa a prior laterveatioa haa kfl a aiiaary 
paralent iatula. 



i 



GENITO-URINARV SURGERY 



71 



TW oiMlf»4wicatioM to Bcpkrectooiy aie: 

I. lomttdcat functioning of the remaining kid- 
nry. 

a. PirMMiiici €i a iMftriMit quantity of henltliv 
renal po i t uclij r uu in tht cyMk kidney and which 
• an Mtisfactorily ful&ll the urinary (unction after 
rxtirpation of the cyst. 

3. The •OMNUtt ol adherencca of the cyst to neigh- 
horing offBUH. 

The aiuor eaten at length into the cooiidenuioii 
of the coiHrioiw under which a nartial nephnctomy 
only b imiiiiiMnili. Theae cooditiooa have already 
heoi fenenBaed hy Knemmel and Albarran with 
whose \'iews the author apparently ooocnra. Other 
operative procedures are auo diacnsied. 

The work condodcs with the details of 11 new 
cases. Of these 8 were personal cases of the author's 
ah! ; rr cases in the practice of I.amas and Mondino 
not Ml' hcrto pubtishdi. W. A. Btrvsw. 



Meets, H. C: 

Detoctloa. J. I 



Its SltnlScance and 

i«««i Si. if. Alt.. 1916. ix, 351. 



I 



The author defines urooephrosb as a retention of 
urine in tbe upper urinary tract and believes that 
the rignH j cancc of this urinary staab is dependent 
on three things: (i) its effect on the physiologic action 
of the kidney; (3) its effect on the anatomy of the 
parts involved; (3) its effect on the midiial urine 
and the results of its absorption. 

Under the fint heading the early ^tage of a stasu 
produces an awraiia and atrophy, while secretion 
stops when the intrapdvic pressure beconMS 73 nun. 
of mercury. The degree of back pressure present 
depeadi upon the completeness of the ol>stniction. 
its pannanency. and the rapidity with which it is 
reduced. When the obstruction b sudden, com- 
plete, and permanent, the kidney becomes isolated 
and its functional value ceases. If but temporary, 
the degree of destruction depends upon thr time it 
has persisted. Functionating kidneys have re- 
mained after an obstruction lasting from ten to 
forty days. 

Stasb may produce an effect on the anatomy 
V ir>-ing from a slight deviation in the outline of the 
• > vrr border of the pdvb and of the caUccs, to a 
h. Ironrphrosis of 30 liters. Authors vary in their 

.11 ion uf the effect produced by a sud<len. com- 
r obstruction of the ureter, some holding that 

^ followed by slight distention and atrophy of 
tbe kidney, and othm show by experimental work 
that in complete obstruction of the ureter seldon. 
If ever, b tbere a true primary atrophy but almost 
invariably a hydronephrosb rnults. 

Under the third headiaf comes the effect of ab- 
sorption of a substance p obono us to the system with 
all the sjramtoms it prod u ces. 

The eaify detection of uronephnMb b made 
possible by ureteral catheteriaation and the proper 
tnterprctation of the pydograms in selected cases. 
The author believes that urinalysb b of very little 
value and too much reliance should not be placed 
on the symptom of pain akme. In interpreting the 



pvelogram. if the early case of aiaab b to he 
ntaed, dbieatioa and dbiortion of the malar and 
pchrb caanoc always be relied on. but a devlatioa 
in the flow of urine from the kidney to the Uaddw 
must be looked for, as an interfereaca with tUi 
phyiiologic action always p cec a de s aaatOHic dMapt 
in the non-infected case. Citreaw cam anal oa 
eaercbed in intenreliag at operation. Iftiow of tha 
upper ureter prooudaff stasis. In the pydographic 
interpretation in the early case it wonla appear thai 
a dose study of the comparative local foa of the 
ureteropelvic junction to the pdvb and tht 
at which the ureter enters the pdvb, b 

If. L. Savroan. 

.Smiih. R. M.: PysOtia of infancy: Mode of In- 
fection. .In. J. Dit. CkUd . 1916. &ii. >js. 

The aut hor gives a very good r^sum^ of the subject 
with numerous references to the literature. He 
tabulates the results of his study of 71 cultures made 
from t he vagina, vulva, and uret hra of 40 infants and 
young chihirrn. This investigation was undertaken 
to determine if this region was in fact a pomibk 
source of infection. .Ml infants over 18 hours old, 
except one. showni a growth from vaginal culture. 
All the vulva and urethral cultures were positive. 
These findings are in accord with those of Scfaaddfall 
while others have found bacilli and cocci in the va* 
gina and \'ulva of infants in differing proportions. 

Smith states that pyelitis of infancy b much 



common in female than in male infants, the pro- 
portion bdng about three to one. The colon hacSaa 
b the offender in from 50 to 90 per cent of cans. 
The pathology of the condition b wcH established. 
In uncomplicated cases the pehrb alone b involved: 
ami there thr Imal lesion b simply a low grade in- 
ffammation. .Many cases show in addition dqpen- 
erative changes in the kidney substance due to 
extension of the process inward from the pdvis. 

With these facts as a basb the two theorica as 
to the mode of infection, namdy. the 
urinary, and the descending or hiemati 
discussed. The theonr of ascending ' 
its greatest support from the large propo r tion of 
cases among girb. but it b supported oy very little 
experimental work. From hb obcussion the aaihor 
concludes that the ascending theory of kidney in- 
fection so far as it applies to the pyditb of inuncy 
has not been proved and the facts are against it. 

Infection by way of the blood and hrnmhatics 
rests upon «urrr ground. The usual OMMe of infec- 
tion i ^ IS described as follows: From the 
intesti or some other source hactcfia gel into 
the Ivmphatk veascb and then into the blood, or 
possibly directly into the blood. After reaching the 
kidney they paas through the alominili awT are 
excreted at the pdvis. Thc>- riihcrpamout of the 
body without doing damage or they set up an infec- 
tion at their point of excretion, the pdvis. During 
their pamagr through the kidney ihev may caute 
more or less damage to t Hat organ. Which of these 
alternatives occur will drpen l upon the virulence 



7* 



INTKRNATIONAI. ABSTRACT OF SI R<;KRY 



piMi bv otiMloB lawaffd 



umI ckarancf ol ilir bacteria aad oo the 
of ihr iocU\-itliMl ami ol the local ikmtm. 

Coloo UmUU. bcc«u»c ol iMr low pallMicaldiy. 
cattw liiilr or ao daauar to ikt kkuty aabMaiica 
in ihrtr prapot ikfOMfk Um orgaa. lafcciioo ol 
ibr Udacy may t ' 

IfOCII IM pelvic I 

•laarr of ibr kidaqr of grtaler 
•oil* aati prcarou a coamUcatioo of, or momI to, 
Ibr u«iuU paibologjr of IM diicoae. A§amm lo 
ibr auibor thr»r varioiM ttafM are «il MabliiMd. 

Tbr inir»iin«l tract b tbe BMMt ttktly Miiree of 
iafmioa m tHr mi^Jorily of caaci— coloa badU 
iafcctioB ntcaUaal aooicca of infection, 

MKb aa i> (oniQa, and local tcptic h tk m 

ai* io^Mirtaiu ia caac* wbcrr otianhim olhrr than 
Ibr coMO badOoa arr found. TUt itateflMnt u( t hr 
BMMk of iaifctioa in pyrlitb tatiiiat all tbc con- 
ditioM ob a u iro d cscrfx ibc greater frequency of tbc 
diecaie in fcmalea. Tbe emiaaation for tbie tbe 
antbor luMb in infection of tae pchfic organs reacb* 
inc tbr kidneya tbroofb tbe Ijmipbatici and blood 
simm. N'omerona ohecrve n arc quoted in support 
of ibb virw. 

Tbc rooduding paragrapb of tbe paper slates the 
aolbor's view coni dady : "I think that wc have 
•nftcient evidence lo bcUr\'r that pyelitis » alwavs 
a blood infectioo and tbat tbe bacteria frequently 
■aia entrance to tbe blood by tbe Ijmpbatics. 
In ihr uncon y l i catad caoea tbe Icrion renalns local- 
iarti in tbe povia of tbe kidney, where tbe orianiams 
are racret«l Secondary infection of the ktrlnr>' 
anbslancc may occur bv Isrmpbatic channrU from 
tbe pelvis. Quttr poaaibly these secondary infec- 
tions account for many 'relapses.' Tbe source of 
I nfe c t ion in ihr majority of cases, considerinf males 
and feosalcs tofctbrr. b ibr ipMiro-inicstinal tract. 
Sone casta aMy arise from infection in the skin, 
teetb. or tonrib. or in some local septic process. 
Ifaanr cases in frmalcs, accounting for thr greater 
Bwnber In thu k% as compared with thr maica, 
ariaa from bacteria rntrring the blood oftrn via ihr 
lyapbaiics, from tbr vulva, umhra. or vagina." 

H. A. FowiAL 




^ nitiOpB. nraa and tbt 

Tbe antboit tbcn discnaa tbe anMiuni of oiea 
and nitrocen wMcb coMtltntos tbe nppor nomal 
level of noniMoiain nltfofen and oraa nkropn of 
tlw blood and condodca tbat tbe coMansns of 
oninion points to determinations )riildini a urea 
nniofen fimre abovr . in too rem. oi blood aa 

rtveaUnt tbe posaibt! rogrn rrtmtioo wMcb 

b at bast worthy ui uokt invcatifatlon. Tbe 
nwtbods of determining ibe co efKc l onl urea excre- 
tion as indicated by Ambard are dbcu awd and 
tbe formula given aa follows: 



K — 



t;r 



\9mfmSmrim 



Tbr authors plarc thr patient on a full dirt of 
regular mrab with no fluid or fowl lirii»f-,n time* 
ami cslimatr the rrnal function 

tbr urinar>' output from sprcimrn.. . ^iry 

two houn iluring thr day and of a tm-bour specimrn 
at night. Obarrvatioos were made 00 soo patients 
and tbr summaries of these results are gnraped in 
tables I, i, and j. A general comparison b made 
of all the tests employed. Table 3 rsiablisbed the 
following facts. 

t. Tbr non-protrin nitronen and urea nitrofen 
indicate a slighter degree of involvrmcnl of renal 
function than the other tests. 



a. Pbcnobulpbonn 
effidenl tend to sbo« 
of renal function. 

J. Tbe lest meal t 
a greater degree of dc|..^~-... .» 
teaia. 



kiK^i^n and Ambard's co- 
iegree of impairment 



ion demonstrates 
.tontbantlieoiber 



T«au >. 



Unn NHiu«M of cho 

danc of Unm laoocloo. and cIm Teal Man! for 

Ronal VWKtlaa* J Am \i in, 1916. UvU. 9^3. 

Tbe ambora state tbat tbe varioua taau for renal 
function bave tbcir own fifBiiGanot and tbat a 
grmtor insigbt wm ba oblainad in tiM dMiactflriitioa 
of kidney ttseases wiwn pbyddana no Jonger advo* 

cate one test to tbe cKlMkNi of aO otbcrt but wiU ^^^,uk. ^^^mmt 4mm tmimXt I n is ug 
aadeavor to intctpm ondinoooidbM to iu own sig- A»eaie7ii 1 »iii»iS>iiiii Mi<>T3 ^ii«r^ i>y« 
yicancr TW^dMrffftbtMidTu^^ ^J«-s«ta-«»«i«»— i.-.sp-iwi<wo-fcwi> 

non*protain ni» 
I of "tbo blood, wa'nh wten o f tbe blood, and 
of nioa eacieiion. 
Table one sbowa ibe relation bet 



iSZSSL 


a^SB^BB 


^J>w> 


£a3£l 


ISi 


WiMT" 


nSSSia 










++ 


t vwoei 


tpwcm 


SpVMM 


IIP* cm 


•f 


|SW«* 

«irw«Mi 


MfMCMi 


atp»«m 


ASPWMM 




4t>WC«l 


«9P«cni 


MSW«MI 


^ 


%»pmtmiA 


AISWOBI 


tap* MM 


MpWMM 


^_ 


S»«eMN 


MpVMM 


• HtCMl 


• p«CHI 


••• 


Apacm 


xwmmm. 


iplraHi 




— — -- 


«a««Hi 










•1 


*¥. . 


ll»„, . 


fj* 



Table j shows tbe relation of tbe non-proteia 
nitrogen and urea nitrogen of the blood and Am- 
bardV ^ - •*'■ '— 



GENITt>-URINARY Sl'RGERY 



73 



T«H« I 



2 In table 6 the autbor give* the foOowiag cooda- 



, ««• MMM*^ casyncmt . 



mmmUmmmmi 


On* 


"Sl^^^ 


mSim^ 


• 


+ 


++ 


+++ 


++++ 


fV+V 


t 

•1 

• 

•1 


n 

• T 


3 

•• 


1* 
It 


s 

u 


1 
JJ 



Table 4 b abo of intemt and value. 



MRToa OB unruot tn 







X«M («a(na lira Vus MtaUw [ VtTA 


"** 


J» 

47 

«7 

•11 


u 

it 


1* 

JO 
JO 
tt 

l» 


7 
f 

•$ 


S«. CmU. Ud. 
Civ DM Nfpli. 
Cte. Diff. NnilL 
ll» DW . N«a. 
S«. CoMt. KM. 
Stc C'Mtt Kid 



A compartton b made o( the degree of impairment 
of function in 73 cases of all classes, except anemia 
in which all the tests were carried out. expressed 
in the percentage of the total figure. 



at vttuaiaan ov r v w^-ii u w n* 




+ 
+++ 



pMlMiWa 



Ufw N of 



40 par OHM 
j$ pcrcmt 
14 P«v ca«l 

4POTCMM 
7 owe— I 



SSpmeam 

It pOT OHM 

>} par CMM 

It pMCMt 

»pwcti 



Tart 



leparcaac 
t7 par oaM 
t7 parcaM 
7 par cast 
f par cat 



l»v«fry' 




n 

6 

10 

e 

•7 

Si 
•i 

H 

•7 

-!2. 



lii 



It 
II 
It 

s 
s 
It 

• 

i2 

If 



:s 

oof» 
e«p» 

OOfP 

IX 




+ + 

+ 
Jt±. 



I. The tests in ofder of their positive aopearaaos 
aie: the test meal, pheoobulp hnnfplw h si cln . Am- 
bard's constant, urea nitrofen of the blood. 

t. A maximal involvement b most freqoeotlv 
teca in the test meal, less frequently in the phenol- 
s u lp lio neph thakin test, and least often in Am- 
bara*s coeAdent. 

Table 7 shows the relation of chroolc rtifMfi 
nephfitb and h)rpertensive cardiovascular diseaae 
showing a normal or supmi o r i n s i r e sp ousc to 
phenobulphonephthalein aM Ambard's coefidcat, 
while the test meal shows some impainaent of func- 
tion. 

The results of test meab for rmal funaion in 
primary and secondary anemias are discussed and t he 
article doses with the following summary: 

I. .\ scale of impairment of renal function b 
proposed, according to which the tests nuy be 
measured. Such a graduation calb to the atten- 
tion of the clinician the relative degree of involve- 
ment as shown by different procedures. Inasmudi 
as each of them has a significance sfKirt from the 
others, comparboo according to thb method b an 
extremdy valuable aid in tlu; treatment and prog- 
nosb of diseases of the kidney. 

7. The level of the non-protein and urea nitrofen 
of the blood must be estimated largdy as the rewit 
of three factors: kidmy efBdency, diet, and pro- 
tdn destruction. In judging of prognosis, when 
these substances are high in the blood of nephrit- 
ics, due regard must be given as to whether thdr 
accumulation is brought about by retention alone 
or through rrtrniion coupled with protein destruc- 
tion. The former offers a comparativdy better 
prognosis than the latter. 

3. The .Ambard cceffident b a better method 
of determining the ability of the kidney to excrete 
urea than the levd of tMs substance in the blood. 

4. The progress of renal diicaie b prabablv 
followed most minutdy by means of the pbeaol- 
•ulphooephthalein excretioa aad Ambard's coef- 
idcat, as these tests furaiih figures ia which even 
small variations are of significaace. 

5. The test meal for renal function, or the tests 
emplo^red. gives the earliest indication of dimJaJslH 
cd kidney eflkiency. It likewise reaches the 
maximum degree of impairment before the others. 

6. Kach test for renal function coven oaiy a 
limited range of the kidnev's activities, it b. 
thrrrfore. a mistake to speak of any test as measuring 
r< ' ' . tion as a whole. The aim should be to 

proper interpretation of the old tests aad 
easily applied new ones in order to obtain a true 
gi^de to the treatment of diseases of the kidney. 

.\.r. Srooa. 

ilunnar. G. L.: Stricture of the Urscar. .V. T. 
y.J.. 1916. dv. i. 

On the basb of an aaalyds of 50 o b s en r a tioas 
Hunner coadudes that the moil ia^mtaat factor ia 



74 



I.VrUtNATIONAL ABSTRACT OF SIRGERY 



Um fltkbiy of vMlcni Mifcti 
of iMkmKmm oad Mow 

CHlMtOllH 




t i | O W li. tad pyiliMiplMlili. an 

Oaiy > of IM ■aikor^ Mriit of 9» CM« 
in til itii in piimliiid lirfonliii loatcoHtte- 
footd mrim «•• fofoJ, btH im mify j latumm 
wm auktan &m 10 cyiikii Moooatofid. la oat 
canUMaaaaaaovUmMMBOiof antataliuio* 
twt ioMaviat a pyiloaipintii^ vlicl^ acosiAw 10 
t>a laifcort coaoiytioa, wai daa tanwtoarfc tauwr 
ilwaialoaliBiMiiM. 

Ooapalul akaoaailtfH oppaioatly doaoc pUjr 
■a iaipoftaal iMtia oloiv* pwpoitioa of cat«of 
amonl ttiktaia, Maot muuMr coaM aoc la aajr 
of Mi coMi nan a coapaiul oiigla. TIm awrafi 
Oft of Mi «o coMS woo 3s*S yvu* umI Um averaae 
<taratina of ■jfiinitoaM woo 4.$ yoaia, auikiaf the 
avonti aft at oaael of qnaptoav «i jroan. 

ftlMM of ciMMnrlloa wteii ibejo<allod 
fMBBHlic ahUMrii aiao cooto wUli a piwioai Ua* 
lory of ilMaBMliaBi, aad j caaaa villi a kiatorjr of 
heart Moaa. 

TIm oeamoaco of la caoaa of bOaicnU stricture, 
aad tkt ponadaraaot of caaaa b vhkli the Mric- 
tart oooBiod la tlw broad IpaHaftioiioa, wiMra the 
ureter aoi aa daaf nood aad hraipaatic aapplVi are 
oanaailva of arotcral ouktaia boooadai loiaMiilMwl 
oa tiM baaia of a qratcoik Jaiactka. Of tW 6a 
anloai vkli tirkture. 1 » of whkb wwn bflatoral, tbe 
a uiiiai t «aa located vithio the broad HgaaMat or 
aklria 6 oa. of tho bladdar la ss: Mar tbe pdvic 
bdn ia 8; aad aoar iba Udaqr la 1 aroter. 

1W anat ianwrtaat asranloai of aroioral stric- 
tara ia pofai to tba Udaov npoa or bladdar, aad tbe 
strictare b feacnalljr Ibaad to tba atteaapt to 
totlwai the caaaa of tbeae qranCooM. Oaljr ooca* 
aioaaijr a local poiat of pato to aaa with tbe ureter 
ii foaad to bo fojf Idi 111 with tbo aito of tbe atiic- 
taoa. Tbe l otifff <SagBoaia to tbeae caaaa dcpcada 
apaa aoBBiMPa saQioavaaalc aaa cyatoocoDftc oaoiiiaB 
for aieienl atoae aadapoa tae lofalltatioa of 
aa obatradioa apoa tbe jpoaaMa of aa ureteral 
If tbe ureteral ttrictafala aoc of aaflkicat 

of tbe boaiie oa tbe tot onadaatioa, tbe 
be owpedod bocaaae of aa oiMm 
la aoaw iaataaoaa. aba, tbe fot 
of otficMia aaay be ooeed apoa tbe 
a few boan after ufeteral catbeleiiaa- 
iloa, of aa aaaMM^jr aevert attack of pato or, to 
tbe preeeaoa of tofecdoa. of a eevan attack of pjMi- 
tia. By aatofcat a coaaacaiiea oaMdaatioa^a toaar 
«as mdh, a wiake pobN of obetractioa aMrfcaif 
tbe aniciaia area caa ae aaeiitaiaed. latonaitteat 
tutt** of ooHc to aacb caaaa of iadpiaal a ti ie ta ia 
aia paiticatoily pr ea e to oocar at tbe 
period, oa accuuot of added coafaalioa, or < 




albr oa the baab of caafBilJaa feioaim frtttof 
cblBed, catcMag cold, etc. 

Ia woMoa aa area of tbickoaliv caa ofloa be pel* 
paiod ibfoagb tbe vaiiail vairft* Cynoecepy, 
qaito fiaqaoBihr lafaeb aa oideaHMoaa aad ooafaat* 
ed aioloral o iifca . 

laienaittoal altacka of leaal cottc. doe to aialoral 
atdttavi. aaqr oiIbi lor y aait »itbaat th e difolop 

■tb that b atabbaraly laablain to lavafa tiaoi- 
■seal BMjr be aaipldoaad of beiaa dae 10 tbe pioa* 
of atrictare of tbe ureter and particularly to if 
tovafi tfoataMni* are followed bv acute 
pyaUtb attacks with high tcaiperaiare, cbiOBi pato. 
Boaaoa, aad voadting. 

Tbe B oa-to i a cto d caaaa of Haaaer'a aeriaa 
aa a rule, a biatanr of abortor daratioa aad 
raaal pehrca boldb« leaa flaid tbaa tbe caaet with 
lafactioa. to 16 aoa^afected caeca tbe avaraft 
daratioa of aya^Aoeia waa two aad a lialf yoara. aad 
tbe avarafa aiae of tbe liidaey pdvb to 10 01 the 
caaea waa 19 ocaL la oae oioaptiooal caae tbe pel* 

coaUng infected. In 18 uifccted caaea Um 
daratioa of svmptooM waa 4 srean, aad the 
aiae of the kidney-pdvb in 1 5 such caaea waa 98 ( 

The ideal treatment for stricture of the arotcr b 
by dilatioo (rom tbe vesical approach. Haaaor's 
work being coo6ned to women, the B Mtb od a to tieal- 
tng ureteral stricture, aa developed or aaneated by 
Howard A. Kelly, are dbcaaaed to tbb article, tbe 
careful peroaal of which wfll deawaatrate tbe iralae 
of tbeae aoa-operative fonat of trBeliaeai. Ia 
caaea without infectioa aad without aacb laaal di»- 
ttirbaace a cure caa be effected bv thcae mraaa, aad 
even in such with iafectioa il the kidney pehrb b aot 
materially dilated oocaaioaally brilliant reaulta auy 
be obtaiaed to poraMaeatly daariag up ajraqxooia 
B tbroa^ dilaiatioB 



iafectioa tbroa^ dilalatioa and laVage. In 
with iafectioa aad larfe roaal pdvea patkau 
laay be reatorod to appaiaatty pertea b eoltb by 
eliaiinatiag ureteral ooatractioa, thereby laUeviag 
pato aad toiic ayuiptoaM. 

If all ooaaervative aMtboda of vealcal approach 
faU, operative raUcf anat be ooaeiderad. la tbe 
preicace of aaitotcral atiklaio with a Udaagr of 
utile or ao faactloaal vatoe, foaaoval of tbe iapafaod 
or dead Udaey b iadlcatod. aa carried oat to 6 of 
Haaaer^ caeca witk eatbety aatlafaciory leaalta. 
Ia tbe praacace of a atricture located high, at tbe 
iaactioa of tbe Udaey pdvb with the ureter, aoaM 
fona of Hi e to aiu o r o p laa i y, or partial py ele ct o n iy. 
or Ugb tattoaof tbekldaey to coaaecttoa with 

pydotoanr, aftor caiifal dOitatfaa of tbe aanawtot 
attbe p yeiaM ii a t etklaacttoa,w1p B e faH ybrtoftba 
deabadiwalt. If the atrictaia b lowor aad abaat 
tbe bnabar or pdvic briainiioa. 



tbo otrictara aboaid be JeBawad by faaalaaiatfaa of 
ead of tbe aiater lata tbe oeloa or to tbe 



For lower atrfctaraa aoer tbe bladdar, 
wbfcb M far have beea treated with iaiplaieHoa 
of tbe eevorad healthy cad lata the coloa or bladder 



GENITO-URINARV St'RGKKV 



75 



«riih. inditfereoi or qtiMliooable mulu, Hunnrr 
rtcommeads Um untmant by ratrooide dllalHion, 
The urvt«r b iupwiid by aa atnpcntooeal iacWoo, 
aad tWiBdMd portion o( the chanDd is dilated with 
iocnativt iiaBt of the French gum dasUc bougka. or 
nccal MNUidi are paned until the stricture is dilated 
to a diameter of from 0.5 to 1 cm. The ureteral 
iacWoD ia then tkthm doaed at once, or, in case 
of Bimtfrfactory dilatatioQ or undue traumatism 
of the ureter. Ml oficn temporarily to favor urine 
lirainage. In 6 of Hunnera 8 cases, treated in 
thi^ manner by retrograde dilatation, |>erfect results 
were obtained so far as me asu red by relief of S3rmp> 
toms and ability to catheterise from below. 

Least suited for retrograde dilatation are the 
cases in which a pjrelograpUc absence of enlarge- 
ment of the lumen above the site of the stricture 
has been ascertained. In these cases a long and 
tetfooa course of boogie treatment from the vesical 
apprcNurh may finally yield satisfactory results. 

M. KaoToaiTNKB. 

BLADDER, URETHRA, AND PEinS 

RuMn. I. C: Bhwfclsr Synaptooia in Women, with 
SpecinI Rafersooe to Aasoctetod Gyneoologlcal 
PaCboloiy. Urot. fir Cmtmm. Itn., 1916, u, 508. 

In a series of 10,000 consecutive gynecological 
cases at the Mt. Sinai Hospital, 875 cases gave 
bladder symptoms as their chief complaint. Fre- 
quenc>' of urination is the most common symptom. 
Thb may be due to physiological changes such as 
diet and weather, but more frequently originates in 
a pathological condition. Painful urination, burn- 
ing, diflknity in starting the urinar>' stream, com- 
plete, partial, or rdative incontinence are present 
alone or associated. Hematuria, concentration, 
ardor mrina, or pain in the hypogastrium are 
sufficient to require an examination. 

Correct interpretation of the urinary symptoms 
requires a complete examination. The personal 
history should be carefully taken as the first step. 
The second step is ph^cal examination. Inspec- 
tion of the external gemtab for eczema, excoriations, 
intertrigo, clitoris hvpertrophv, enlarged nymfdue, 
purulent discharge from urethra and vagina, pus 
at the Skene doct orifices, cystocde, urethral pro- 
lapse, or a caruncle, may be present as a cause of 
the vjrmptoms. Dribbling may be present. Hypo- 
ipadiui is rare. 

Bv p^tp^tinj in the vagina, swelling in the urethra, 
tenaBOMBS in the trigone, foreign bodies, tumors, 
and l en d ern e s s along the ureters may be detected. 
By palpation, gy nsc ologi ca l leaiona which cause 
bladoer symptoms cither by pressure or which 
extend into the bladder and urethra by contiguity 
can often lie outlined. An acutely antevcrtcd uterus, 
as in early pregnancy, hy pwssure and venous stasis 
may cause bladder irritation and even bacterial 
invasion. Extreme retroflexion will give the same 
rcsohs. Cystoscopv will give a good picture. 

Tumors, cspcdalfy those low down in the pelvb, 



will cause bladder irritation, and will cause vascular 
obstruction. Incarcerated ovarian tumors may do 
the same. Advanced carcinoma of the uterus 
affects the bladder and ureters in 10 to to per ceat 
of the cases. Inflammatory conditions of the btnad 
ligament with large exudates freouently extend into 
tb(B bladder. Pyosalpinx, ectopic pregnancy with 
hematocele fomiation, and infected dermoid ovarian 
tumors may cause urinary trouble. Pelvic or general 
peritonltb and pelvic hjematocele are usually 
accompanied by bladder liisturbances. A diseased 
appennix, sigmoid, or rectum not infrequcmly 
Bsical lesions. 



Cystoscopy and urethroscopy are the deciding 
steps in bladder and urethral examination. Diver- 
ticula, distortions of the bladder from a tumor 
masa, varicoaitics of the mucosa causing hematuria, 
trabecule resulting from oventraining, local or 
general cystitis with ulcerations, hiemorrfaafe due 
to various causes, foreign bodies, tumors such as 
polypi, papillonuta, and cardnomata can be in- 
spected. Sections can be obtained from tumors for 
microscopical examination. 

Smears should be made from aU urethral and 
vaginal discharges for gonorrhea. The colon 
badlltis is frequently a complication. Typhoid, 
influenza, pneumonia, diphtheria, and tuberculosis 
may cause cystitis. Tubercular cystitis is disgnnsfd 
by finding the bacillus in the catheterised urine. 
Pyuria with acid reaction but free from bacteria b 
suspicious of tuberculosb. 

The different bladder conditions nuy give rise 
to a series of symptoms which mav resemble dif« 
fercnt pathological lesions. The real cause must be 
thoroughly searched for and located. Vaginal and 
pelvic examination followed by urethral, bladder, 
and kidney investigation, and if necessary, labora- 
tory confirmation, are necessary for a satisfactory 
diagnosb. C. D. Piacasu. 

Rovslng, T. : A .Method In the OpcraUvc Treatment 
of Extrophy of the BInddor (Eioe Meibode zur 
Operation von Ektopia vesicae). Tr. Xt Ntrtk, 
Surg. Ccmg., Goetcborg, 1916, July. 

Rovsing disctissed the various methods employed 
for cure of extrophy of the Madder and c o och ided 
that it was best to abandon the hope of being able 
to establbh normal relations and that it waa per- 
haps better to sew the bladder around a Pesser 
catheter, as was formerly advised bv him. In one 
case in which extensive cicatricial tissoe waa 
present from previous operations and prevunted 
the em{)loyment of thb method he made a colostony 
on the left side, and after extirpating the bladder, 
sewed the trigonum into the dosed rectum and ob- 
tained a very satisfactory result. L. A. Jobmeb. 

Suture. Smt.Cymtctr 



A. H.: A 

O^.. tQtb, szfii, J64- 

The difficulties encountered in closing the bladder 
are: its low l)ring position in the pelvi*. the thick 
sbdominal waib, and tearing of the bladder after 



INTERNATIONAL ABSTRACT OF Sl'RGKRY 



it iMi hvMi teditd. i*vt4KMkMi« awftwr ml 



iMf OMt MM MV M^r NifBCtOllk JMT pWM4l 
■itMM k laaOTtMl hMan iW hlMlilBr Ia macli 
It |Vf vvMt ftmhrf ntnwpn <■ the iwnMMi bjr fip* 
|iU«. II nukr* 6n«i •uturlai a( ihr bUdtlrf aniMcr»- 
Mffy. It MVT* vahtfibl* ti«». aad U flwrfci Mm i Wbi c 
IraM ilw Urflt vdhM of tiM tMiiMl mtttn of iK 
o My wowmI wMcIi It wrtot tnt- 



OUHTAL OROAm 



TW Mvwi of iW iImcmi of tlM leMb b prabobly 
4w lo a cooMMttioa of ciMM. oo rfagle omt of 
vMcii win oipliia ffvity caw. TImic It oo lonarr 
amf qpialloo tiMl ll» iro^iil |itomi doM wM play 
aay pan la ht <iotcaM. BuiiWafif haa advaarcd 
iW virv ikal adkorioaa aa ibe rniili of fcBial peri> 
loailli play aa laipoitaat pan In thr nan <lc«rmt. 
■RlMagB OfMdanI Im* altnnp(r«i lu rxtilain ihr 

•nwi m a umiioa of type. Oibcn bdirvr ihai 
a wty tlMMi MwaiwrliiiiBi aaipiadlaf ike icatb 
pamaia il» onaa fioM arfgrattwa Tbe autbor 
aa a coaimiotory caoat, iW orftdcncv la the 
of tbr ardWag ibcn of the latenial 
irlr and a weak co^loiacd icodoe. •mr> 
lag lo aBoar ivtractioo of llw intb by the rrrmasler 



Of thr coa »p lk l fcm» of aoB<dcacnu of the Icatia, 
hcraiji u bv far tbe bmmi froqoeot. aa almoat every 
caae baa a biraia aa aa accoomaaimeot. Invcstiga- 
tioaa have dearly abowa Uuit there it a marked 
atioiiby of the a ec r e t ory (ttactioaa o( the rrtainrd 
tcaua^ Tbia atrophy bcipm quite early. m> thai thr 
advbca operatioa at aa early an ajtr a* i he 
of ibe child will pemil. the lo«r%i limit 
art i«o yean. TMaor fonaatioo. tofatoo, 
aad tbe amal cvNnpllcatiooa of coageaiial hernia 
aio iMl very rare aad araat he taken into ooaridera- 
iloa la ■litbiag the qaeiiion of operation. Hypo> 
pkaitarlaai b hoc the icsolt of aoo-dcaccai, not 
It aol Infrcqoeotiy acromnanira tbe condhioa. Tbe 
QpifMlea baa hot Bitle tateeace apoe tbe lack of 
dmIapaMM of aiale aciaal cbaractcrbtica. to 
tbM a gnafdad pmaanah aboold alvajra be i^vea 
for aocb caaaa. aa vol m tbe poaaible de v elopment 
of tbe tcacb after opcratioaa fai yomg adahA. Tbe 
aMbor baa aaed tbe Bevaa operatioa la moat of 
It to be Iqr far tbe beat opcra- 
Gai 




J. B.t 



of tho Praoialo. 

i«i6. asiii. 341. 

S^alM laviem the iMMWtod caMO of aarcoouia 
aad rbabdoanroMaia of the proatale aad diaaw 
to tbt faa that aooe of tbe 

tbe ibaliduMjina Tbe farfiaqpMcy of 

fbabdnayoaM of tbepraMato b MahHiaad tiy tbt 
lapon of WolfnbcrMCi vbo ooMCtad oii 
jSofa 



tavolvliV tbe MoMair Kaufmaaa't throe 

an i— MMfU ed la delaU aad to tl 

a Mpoft of a can ooMiag aador bb owa oboervaiioa. 

TIm patltat «m 40 yma of apt aad whea ftiai 
teen the toawr »M appawn|y pffaanr la the praa- 
• '■•- aad bad aol oMoMdad beyoad tlia ttmUatloat 
capiMli, A vrlda pnlanl oitlfpailoa of tbt 
•Mtmi aad virfcal aocf 
to tbt tochaiqm of Yomg. 
tivo raoah wn oanBHt. the patlaat not having 
ovMi ariaary lacoaliaMwe. 

Two tiwfiilbf after operatioa* rapid rocarraaca 
took plan aad fatal termination waa the out c o n a . 
ralnlcM baimamria waa tbe only svn^Mom prior to 
opewlon. It bad ban aMaifni (or three aiOBtha 
before the patient bad aabodtted Umaclf for 
Inatlon. 



pafffamad* accoidiag 
Tbe ioMMdiate opera- 



O.i fnotaiectomy. ft XI Xtrtk. 
Smfg. CMf.. Goetaborg. i<ii(> JnU 

The advancea made during thr laat few yeaia la 
the operatioa of proatatr* •-'•>' -<^Huiat in tbe two* 
aiaitr operatioo (prdlnii) >|Hibic cyMoatony 

or rcaidual catH"'^" - ...icolioo to hvnior* 

rhage (tampon good dralnaae (eitber 

by BMsaaa ol a «■■!« -ti|>ia|iuiHcopeaiBgorby awaaa 
of Pnaar'ft cathrtrr). and cMwdally in tbe ob»- 
plojrmcot of local ammthcda (Htbrr epidural. 
aaCTal. paraaacral. orbrttrr»iill ihr<limt anjn4brt- 
iiation of the proatatc and aurruumiinii »i met urea). 
Rrcrntly thr author haa abo prrfurmni vaMriomy 
for thr prrvrntion of epididjrmiii*. 

Of 114 ra4r». 16 were operated upon |>crinraUy; 
7 dir«l Thr hi^ OKMtality rate i» dtu • •»- fact 
that thr indicatiooa (or the operaiiot ricd 

too far. .\a haa prevkwaly ' - -^ by 

larad the perineal operation -on- 

agr than thr auprapobic bf-vcnt^ |kiiiciii-> «rrc 
oprrairti upon auprapobically with a m«>nality of 
7.J per cent. In ao caaea a luprapubic fiatula waa 

In i caaes the operation was complirat ed by a 
bladder abaccaa. and in a othen the nniaal vcaidca 

were r emo v ed with thr proatatr. V^ '~- *"< — 

orrbage waa prr*cni in anv caar. a: 
b pe r formco under local ancathr«*a u i< «imu»( 
bloodlcaa. In tbe bat 14 caaea no tampooade of tbe 
hedofihepraatatewaadooe. Hanaorrbage did not 
occur. Complicationa diuing coavalcecence out- 
aide of the cooubob oan (n paeoinonla. broocbitb. 
emboUam) were cpidldyMitb, bOedlon of the ab- 
doodoal wound, urinary retention with (ever, 
urethritb a(ter introduction of a caihcirr. aao 
atrkture of the urethra. la ooc caae the edgea 
of the bladder woaad doaed ap over the bed of the 

ladicatioBa for tbe operatioa art: catheter life, 
traaaieat total rctcaUoa. bcbaria pa m dod c a, aad 
prolimgid aad lacnniag arlaary diatarfaaaoea. 
la than caon la whkb tbe wmtnk ooadllioa b 
poor, la braaddila, aad to advaand aitarioa cl awri>, 
ope ra doa caa bt pwJMMad nrraaJMiaBy, bat oaiy 



GENITO-LRINARY SURGERY 



77 



wiihout nafcotb and after i borough prcUmiiury 
•iruinaft of the bladder and iMdiag of Urfe ouao- 
ttiir« of flnida, and alter the admimatratioa of uri- 
nary antitqMin- In arvere urinary infection, or 
where there are tymptoma of urinary inauflkieocy 
(poljruria. apedftc gravity below loio. low nitrogen 
excmioQ). and in gastro-intestinal urvmia, ufMrra- 
tioo may be performed occasionally. Cancer was 
found in 9.7 per cent (14 cases) of cases. In 7 
cases the **^*r*''*^ was certain on account of the 
decreased mooQity of the prostate. The operation 
in camrr should be performed only where there is a 
p(n<«iMlt!y of remo\'init it mtirely, otherwise sympto- 
'iment »houlil lie given. 
\LL reportr<l 100 transvesical prostatec- 
luiiuc* performed for urinary retention. In the 
tir»t 50 cases lumbar anitsthesia was employed — 
\ (K-r (rnt (ropococaine solution. This was dis- 
ioiitiDUfl. however, on account of severe poisoning 
cases and one death due to it. and was followed by 
local amtsthesia in combination with light ether 
narcosis. The author tillc<l the bladder with air 
before the operation, followed Freyer's technique 
principally, and used KuemmeU's after-treatment. 

AmoHK the ioq cases there were 12 deaths, 11 
per cent. In 80 cases a good result was obtained. 
The author operated if after a preliminary retention 
catheter treatment lasting two weeks there still was 
MO ccm. of residual urine, or if the urinary attacks 
were »evrre; occasKNially also after acute attacks of 
retention for sodal reasons. .Ml |>atients, however, 
who had prolonged retention or showe<l signs of 
urinar>' {wisoning or infection of the urinar>' tract 
were treated with the permanent catheter for a long 
time previous to operation, and if the symptoms did 
not cease the operation was not performed. After 
the operation a catheter is inserted in the urethra 
in addition to the wide suprapubic drain, and 
irrigatioitt of the urethra around the catheter are 
employed freely to avoid epididymitis. To avoid 
stricture sounds are introduce<l once a month for 
six months after the operation. In one case the 
bladder wall had closed completely over the inter- 
nal urethral orifice. 

In Q cases a probable diagnoate of cancer was made 
clinically. In cancer of the prostate the radical 
operation by the perineal route should l)c |>erformed; 
toe author, however, resorted to palliative treat- 
ment only. 

Kkehoen stated that he had a mortality rate of 
1 1 per cent, the patients themselves demanding the 
operation. The time of cure is about thirty days. 
The result is good: 16 patients <lo not have to void 
urine at all during the night. 1 : (tatients only once, 
7 patients twice, and 6 more than twice. Infection 
of the urinary paiaafM b no contra-iodication. 
Cancer of the prostate b common; as it b diffictUt 
to diagnose, early operation b neccsaary. Recovery 
in cancer b just as rapid and the functional result 
is just as good temporarily as in the other cases. 

KtRCN perf o rms partial removal occasionally in 
parenchymatous hypertrophy. He always em- 



ploys the trans vene indalon through skin and fasda 
(occasionally also a small incision through the 
muscle), transverse incbion through the bladtler. 
and drains from one comer of the indsion. In 
infected cases irrigation of the urethra and bladder 
are employed before operation. 

WiS IloLST analyzed the material of Prof. 
Dahlgren from the Sahlgre Hospital, including 
I4i cases of prostatic hypertrophy. Of these 42, or 
ao.6 per cent, were operated upon under local an- 
arsthesia, the others with lumbar aiuestbesia. 
Twenty-eight were operated transvesically. 3 
transperineally. 10 with cystostomy, 1 with vasec- 
tomy. The mortality rate with transvesical 
prostatectomy was ii.q per cent. Of the non- 
operated cases 8 per cent died. The duration of 
convalescence was 2q da>'s. The functional results 
were good — 8 patients do not urinate at all during 
the night, .) once, 4 twice, and 2 three times. 

Hi'iL |)rrformed 40 prostatectomies (} perineal) 
with a mortality rate of 10 per cent, and i} cystoato- 
mies with a mortality of 50 per cent. He operates 
under local and sacral ansnthesia. Complications 
after operation are frequent: 75 per cent. Cancer 
was found clinically or bv the microscope in 15 
per cent of cases. If the ffiagnosis of cancer b cer- 
tain, only a cystostomy b performed. The hard 
consbtenc>' of the prostate b the most frequent 
symptom. 

Bai'ER examined 32 out of ^7 extirpated prostates 
and found cancer in 5 cases. 22 per cent, .\lthough 
the material is small it neverthdess shows about the 
same |)crcentage of cancer as do larger series. One 
must therefore figure on a fair percentage of cancer 
cases in all prostatectomy operations even though 
the clinical symptoms point to a simple h>'per- 
trophy. 

Rovsisr. stated hb belief that it b certain that 
the hypertrophy arises from the para-urethral glands 
as the prostate surrounds the hyjiertrophy. and the 
patients therefore <lo not liecome impotent after the 
o{)eration. lie therefore does a total removal more 
frequently than formerly, but has had only 60 cases 
so far with 10 fatalities. In 11 operated cases the 
result was bad (retention, bladder stone, stricture 
of urethra), fie has performed 130 c>-stostomies. 
however, and he always advocates that thb should 
precede the removal of the prostate, it being 
especially indicated in pyelitb to decrease the viru- 
lence of the infection. If the patient desires it 
later a removal operation may then l>e performed, 
as the operative mortality b from 10 to to per cent 
and recover)' can never be guaranteed. The 
aseptic cases with kidney insufficiency frequently 
deceive one and are best treated with c>-stastomy. 
He protested emphatically against the tilling of the 
bladder with air. on account of the danger of em- 
bolism. 

SCHILUKC has performed jo prostatcctonica. 
.\fter the operation j cases of cancer were found 
among them. He b very well satisfied with parasa- 
cral anaatbcaia and finds local anesthesia of the proa- 



7« 



INTBItNATIONAL ABSTRACT OF SURGERY 



lait loo fo«mliriif<t TIm ivmIis tun food, tn 
rate of ksMortlMat km liwpiWM for i$ MiMiiio. 
Tbr bladdw vowM It doMd rwplmltr mommI • 

lortutd^yt. 



«inlili 



Imi 



I«J 



odooik. 



for optratloB mfy 
Ohm of tkt tofl 



Mttdi OMVjr wt MBoa co— iwy py o ▼• 
toaQf, M MWikMd D]r Rovrin^ Hm momoiIc 
port of tW willM it Ml mfy limhrnrd by tbt 
h > |irft r oplpr bof h b tito dBotod ( L tw gdo rf ) to tht 
• podMl for«t wkkk b opts immrd tbe bladder 
lo t qntitk. 

WMtuoiod o Uigt prottoic — 4$$ 
ilwoaih ft tftatvirtt iKltioa wMor 
* la coMhisotkNi with locol oaat* 



I 

Key do« mi coMidar tW opmiioo for cUalcalhr 
ditgnnted cotn of caacir at tbMlutdv hopcktt u 
•n tW fatdt ud ooaaoctivt Uwm of iao peivit 010 
Of J optratod caaia, 1 Imb nvad ooe 
yoact witlMvt la ainta c o and t for 
OM yoar bM villi 



Puioavt rcportod «o traatvcakal prottatocto- 
■dotwitba BMrtalityof4.orSpcrccai. In 5 



wat very prolooftd 00 account of 



FbUBix ciiip kwro d local aaaotbtaia of tbc proa- 
tato la 57 catca «itb 7 dcatht. Before eoodaatioa 
of the ptottaie tbe attbor made a drcalar lodaioa 
of ibc bladder nmooaa and witb tbit p roce du re 
oever bad a fttrktore result. He never e mp loyed 
a naidual catbrter aftrr the opcratioa. 

TAMMBao estcaded tbe indkationt for tbe opera* 
tioaaadtbereforealaobatabigbaMrtaUty. Among 
14 caact tbcre vera 5 caact of cancer. In oae catr 
tbe proaiau ""jlbiid 500 gm. Local aantbeaia 
bad bcca OMappoiatiac aad be tbercfore em ployed 
ctber ia piiifwiacM. All opcratod patleau eaoept 
oae pumWi d tbdr texual f unctloat. 

BACKSB-GftooiBAaL meotioocd tbe OMlbodt of 
da mmJaia g ibt f aa ctioa of tbe kbJaeya before opara' 
tioa. By maaat of curvet be tbowed tbt diiiiiali. 
rilinpa ootlloa. apadfk gravity, albumin, and 
pbtaolMripboaapbUMMia oaetioa. A definite de- 
I la tbe cacmloa of ibcae tabttaaoet occurred, 
of tbe laat, after a cyitoiiaaqr. at tbe cet- 
tbe mcatioa iatntartt tbe kidaey. A 




latff protutoctoawr p to da cad 

cijijciatd tat aaiployBMat of cyttottomy. 
Il aa aabaaiabia piaotdart rtQuirim 
infection of tbt 
aadtioaaiw 
ttatod tbat wbile moat operatort 
coatral batotorrbaft wiib tampoaa bt emp l o yt 
plalia inttciioataad irritttloa witb adrnaUa aola- 

'tOI 




oa tbt n< 
beopcrai 
Rovtiv 
tbeaf'-' 
abou 
iafe. 
latn- 



liiV« 



TtifowAU. antwtnd Rovtlng't araumcoi b> 

las tbai <^ ■■"vti^taai loodaf of tbe opera; 

MUbyf It aaftly avddtd by tbt amplnr- 

" "?^«tatioa wtrt pttformtd o^y 

rtly a vary few cMtt woald 



a KMatoa caibeier; later daily irriga* talatloo 



•r r)'»(o»iomx and rspUiood 

I hr r Aibeter muM be riiinatd 

in dku^am it oat liki 

i* nootttanr to foOow tbt ia- 

I i( with aa i«|actioa of lapit. otbtr^ 
tfAtioot tboald bt t am lo y td. Wkb 
tbt ftrat tignt of ia f tfll ifi i fftf^ft tr iajtcdoa of lapia 
•bouki bt alvoa. Tbott patleau wbo fbd a cy»> 
tottoaty objtctloatbit caa always bave aa •octomy 
perfonaod nttr. 

BoacBOBBVWK doaad tbt ditcaatioa Inr agala 
recommendiiw tbe twotlage operatioa. Tae la* 
frction may nrtt be takaacareof by a cyatoatonqr, 
not in tbe atatt of amkiag tbt urine ttoile, but to 
dimipate tba ftaaral iatoiicatioo. Nevertbaltta, 
after a tuccetaful cyttottomy operation tbe -oaomy 
may be followed by a iranntory unemia. Tbe ia- 
fecuoa of tbt abdominal wound caa be avoided if 
it b left wide open or drained well. In regard to 
bnaorrbafe be recalled Israel'e woida tbat if oae 
did aoc daaire any one need not bavt any. Tbe 
oucttion of operatinf for cancer b a probl em ; 
time may be gained for the patient. 

L. A.JI 

MISCBLLAlfEOUS 

Payne. R. L.. Jr.. and MacNIdar. W. B.t The 
Surtical fVoMam of Unikicoral 
Hanwcurla; Im Oauae aad 
J. Am, M. Att., 1016. bvii. pit. 

The autbor* report their condutioat ia regard to 
•o-called "eeiential" hematuria. Tbeie ooada- 
lioat are baaed upon a atudy o( 11 catftof tbe< 
ia ama aad 6 caaet produced experimentally ia 1 

Of tbe buBuui cttta, tbt kidney wat reflMvod 
could be carefully ttadlad in three; tbt aatbon do 
not ttau bow tae coadifioa wat p ro du ced la tbe 
dogt. In all tbe caatt ttudied an overgrowth of 
coaatctive tiitne, ctuttd probably by kcaUatd la- 
fhmmaffcia, wat dtiaoattrttiid at tbt cuiiikuawdal 
lary Juadioa. It wat baUtved tbat tbb fbnab 
cauttd a coagtttlon of tbt venuk» which lie beatalb 
tht BMMOta of the papObe. Section* through tbb 
nfioa abow thrombnaad, aad la oae or two Jattaarai 
ruplared, vdaa. Tba autbort rtooauaaad tndat 
tba tita of ttyptict oa tht reaal ptivit, provUtd 
tba catt caa be iicpt under obtervatioitr T^ibtNa* 
lotb aad taaMw mu»t be ruled out. If tbb aMatarr 
fait, BMbrotomy abouki bt doaa. Curt iiauilt d 
hi avaiyoat of 8 caaaa la wbkh tbb amibod 

id. Thty do aot coaridtr atphropaqr or 

to be tafldaaily thoraagh for tbb ooa- 

G. G. SmnL 



SURGERY OF THE NOSE, THROAT, AND MOUTH 



IfOSI 

Wacaoo-WUlbim*. P. : The Technique of .Sphenoid- 
al Sinus Esploratkio for Meningococcal and 
OdMT Infactloaa. Britt*! iitd.^Ckir. J.. 1916. 
mdv, ai. 

Bcouae of the poMtbUity of the yhenoidal tiiunct 
bciag the tource of fljrstemic iniection with the 
diplooocmt of Wfichidbmm. the author advises 
routine cjcploration of thcae tiniwet in all cases in 
which the mcniiifococcus has been foond in the 
c ci ebr o s pinal fluid removed bjr lumbar puncture, 
and in tnose in which the ocganism has been found 
in tbe nasopharynx and is associated with symptoms 
MOKsUng infection. 

Hfine sinuses may be explored by passing a cannula 
through the natural ostium or through the thin 
anterior wall. The author prefers the latter method 
for the following reasons: 

I . It b hardly possible to pass a mop or cannula 
into the sinus without previonsly or subsequently 
contaminating it while passing throu^ the narrow 
olfactory fiasttre, in which case the culture yielded 
may be misleading. 

}. If one uses a cannula and suction syringe, and 
the orifice of the sinus b small, the cannula so 
fills the ostium that neither air nor fluid can enter 
or escape and no contents can be withdrawn, as 
there Is no **banghole." 

For w*^^^ entry through the natural ostium, 
the author uses a short silver etistachian catheter, 
sixe No. I, with the distal end bent downward for 
three-fourths inch in a slight curve. The catheter 
is pawrd upward and backward between the septum 
and anterior end of the middle turbinate, and kept 
dose to the roof of the olfactory fissure till the 
nossle impinges against the anterior sinus wall, 
whea the curved end is turned slightly outward 
and the ostium fdt for. As soon as the c a n nula 
is in the sinus, one should trv to force the downward 
curved nonle in its further passa^ backward, 
downward toward the floor of the cavity. 

In g it i nin g entry through the anterior wall, the 
author uses a bltmt trocar and cannula, directing it 
upward and backward so as to aim about one inch 
bchiad the center of the back of the eycbalL On 
mcUng the anterior face of the anterior sinus wall. 
tike praiimal end of the cannula b raised and the 
<ttetal end pttased into the sinus. 

Raving previously drawn about 6 ccm. of sterile 
water into the suction sjrringe, the sjninge noexle 
b inverted into the cannula and about j can. of 
water b thrown into the sinus and at once slowly 
withdrawn. The purpose of the water b to dilute 



thick ptu or mucttt which could not otherwise be 
aspirated. The cootenia should be cultured. 

Orro M. Rorr. 



Brymn. J. H.: The RslntkHi of IMssnsss of th» 
Accsasory Stnuscs to Dtoanses of the Eye, Ea- 
psdally In Children. Tr. Am. UryngtI. At$. 
Washiagtoo, 1916, May. 

Diseases of the sinuses occurring in children have 
been only slightly considered, for the reason that 
these cavities in the very sroung are supposed to be 
so small that there could not oe an Inflammation 
sufficiently severe to cause any serious disturbance 
of the eye. 

That these premises are entirely wrong b evi- 
deiKed by the report of the following cases: 

The first case, a male, aged eighteen months, had 
a very marked exophthalmos on the left side, follow- 
ing an infection from influenxa. On sdmjieinn to 
the hospital his temperature was 104", some secre- 
tion flowing from the left nostril, marlwd bnlginf 
of the left eye downward and outward, lids and con- 
junctiva were oedematous, and the periatiricular 
glands were enlarged. Sttn by the author in con- 
sultation, the diainoab of orbital abscess resulting 
from an infection through the ethmoid ceUs was made. 

The radical operation was then done, the Incision 
commenced at the junction of the middle and outer 
third of the supra-orbital ridge, and was carried in- 
ward and downward along the inner border of the 
nose bdow its middle. The periostetun along the 
iimer wall and the corresponding parts of the roof 
of the orbit was stripped from the bone, and in doing 
so a large quantity of pus was evacuated. The 
whole of the inner wall of the orbit was removed 
back as far as the sphenoid. The ethmoid ceUs 
were found to be badly diseased, especially the mid- 
dle and posterior portion, and from the c ondi t ion 
found it was apparent that the orbital abaccsa re- 
sulted from a oirect infection from the middk and 
posterior ethmoid celb. The amount of pus evacu- 
ated was enormous, ronatifring the afe oif the cUM 
and the stan of ditdoBMBHl of these paru at 
thb age. 'nte abscess naving been thoro uriJ y 
evacuated a strip of iodoform gauae was placra in 
the orbit back of the eye and brought out through 
the nose, and a small gauxe drain was placed 
just inside of the inner nnthus, and the exteiaal 
wound closed by interrupted sutures. The ddld 
made an uninterrupted and quick r e c overy, the 
eye gradually receaiog soon sssumed iu normal 
position. Thb b the voungest patient the author 
had ever seen with such disraird condi t iona. 

The second case, a negro boy, aged eleven years. 



79 



INTERNATIONAL ABSTRACT OF SURGERY 



ImmI hnlgtng «rf ihr Idi vyt to • awrlupd dcfivr ilowo* 
VMd aad ovlwanL iMft wm 
wiilriii tkt umt awl M rin» of 
X*fK]r twrfiMiifam ilMvwfd ao 
iImi ibe lill ofWial raviiy wm ippHwIly Mid 
wilk « illMt OMM whkh «<>rnwd eoiiiMd lo tbe 
ofbil. BiciMil of aU ihoc nrgathft iwtoailom 
it «a» bctftwd thai there vas a gimrth in ilw orbit 
badiol ilMaya. 

Am wiJBfalina ol Um orUi tlwwtd thai at ibe 
JwkiIm of ibo MdiBa aM pottcffiof portion ibrrc 
«•• a dcddtd bdglM of tbt dbmoM toward tbe 
ofbil. Wilb a prow tbe caOft ««« pcrforalrd and a 
Imr qnantity of poa vaa rmoMtcd. Tbo vbolc 
of iW inner vail of tbr orbit. i a efaw MM all the rth- 
■Mid cdla. »n» rmovfld aa far back aa tbe tpbeaoid. 
aad in doiai to a larft abaotM bivQiving tba pottarior 
ctluMid cob and iba ■pbtiwirf tfaraa 
Tbt ipbcaoid cavity waa unonal' 
fBid witb tbick creamy pM. ABi 
pnralcnt Mction baviaf bacs tboMMbly la n i oea d 
an i odo f onn gauar pacluof was pinoed in tbt ipbe- 
sold and ctluaoid rngiont. one end betas lirombt 
oat ibrongb tbe naM>. and ihr ritemal wound doaed 
by faMemiplcd anium. At tbe end of tbe teoond 
day tbe saitae drain wae r e m oved and tbe noee 
touly irni^cd witb a Minrated lohition of boracic 
add. 

Tbe paiirnt made a quick recovery, tbe eyeball 
gmdvady rrcrdinjc wiibta tbe orbit, and at the end 
of tbe ninth day he was discbariBd from the 
boqiital. Orro M. Rorr. 



found. 



C. F.: The Trratmrnl of 

Alhtmj M. .4aa . 1916. uxvtt. 564 



Tbe author diKumea only suppurative coiMBtiona 
of the antrum. For tbe ordinary caaca of acute 
infirthwi be advima that a cotton tan^mn. eonkad 
urhb equal porta of a weak cocaine and adrenaHB 
be placed under the antctior end of the 
turbinate, with another between it and the 
Thcac abould be left in place for from ten 
10' fitaaa ndnotca. The patient b given a spray 
iotalion cootalaiat adrrnalin. 

If nHef b not obtained in forty-eight boun tbe 
aamm b punctured witb Coaklev's modi6raiion 
of Mylm' trorar. and irrigated wtth a ndld solu- 



For t be subacute caaea a dnndaltfanaail opening 
b advocated; wUle lor the dnuuic iafactiom the 
CaMwdl-Lac or tbe Deaker method b advised. 
U tbe frontal sinuses, etbmokls, or taalb aia contrib- 
utory factora. they sh oul d lucciva appropriate 
timlment Orro M. Rorr. 



Johi 



Itt I 
la 



Ueym^ 



W. II.: 
ITbfuac 

mtmft, loia. axvl. loaj- 

Tba aolbor givus a rfaum^ of the recent work on 
the subject of iriilosb 

bodies in the urine. 



much bicarboaate b bat from the blood that the 
adalabmtloa of a csitaia aiaoant of bicarbonate 
fdb to dfaidabb tbt wtaaiy addhy. 

To dftaei aay laadiiicy to thb coaditioo the 
foOowiag tasu ait advocated: 

t. Tbe uriae b csaaiiBad and the 4fHftM of 
aboonaal adds shows that theft b a dblufbnare 
of ontfaary aMtaboUsm. but fatal ■ridtiih may 
occur whea ao abaonaal adds ait fouad la the 
urine. 

Evidaaoe of unusual adtivity in the body's 



defense should be sought for. by determining the 
amount of immoaia aad its icUtioa to the total 
nitragea output. In tbe iridods dtw to the inor* 
ganic subataacas, aa wbm the cacittioo of add 
phosphates b intrrfrrrd with, there b no 
ta tae ammonia. \ high ammonia 
should alwayv make oiw s uspidons of sridosh aad 
further tests should be auMle. 

3. The alveolar carboa dioiide tensioa b dimin- 
ished in arid<Mi4, because theit b a dscwaai in 
the carbon' • blood, part of it betag used to 
neutralise -> from tbe tissue, laeit b a 
deviation then irum the normal reaction of tbe blood 
and an accumulation of carboa dioiide. Thb gives 
rise to the djrspcMm aad air hunger. 

4. The blood-plasma b tested for its bicarboaate 
coatcat rouddy by cetimaling the amount of hi- 
carboaale wUch must be given in ordrr to bring 
about a change in the reacUoo of the urine. TIds 
b spoken of as the tolerance for alkalies. 

5. Tcstingthereactionof thebloodby theuaeof 
some indicator. 

The freouencv with which thb condition occurs 
after tonsU and adenoid operations, b meatioaed 

;lemitbthat thereba 
of the 



1 1000' 



but noeiplanati 
prolonged starvatiui' 
throat. 

Preventive ui e aaui ta recoouaeadcd are: 

I. Examinatioa of the urine aad nuking a blood 
test before operation. 

1. Tbe patient should aot be starved. 

J. Sodium bicarboaatt tbwiH be sdminisicifinl. 
15 grains three timca daily, for two or three days 
previous to operation and a solution cootaiaiag 
45 grslaa adadaistared per rectum one-half hour 

4. EaoHdvt arascular activity, csctmive emo> 
tiooal acftmaaat, sui|lcal shock, aad tbe use of 
aa eaemdvt aaMraat of snaalbsllf should be pr»- 
veatatL 

5. A vefetabk diet should be adhered to for a 
few d^rs prior to tbe operatioa. 

6. MorpMae shoulcf be used before tbe aaaa> 
thetic but aot daiiiig it. 

As to treataicat. the iaiasiiam sboukl be laiptitd 
by a warm enema of magaminm aalpbate, riyeinaa, 
and water. Thb to be followed by come inlga- 
tioo with a 5 per cent aointioa of aodhua bica r boa* 
ate. wUcb amy ha wpainid atvtial liiacs aad amy 
also be glvta laiiaitiiBflDf or aaboManeously. 

Orro M. Rorr. 



Sl'RGKRV OF THE NOSE, THROAT, AND MOITH 



Si 




Ch olwi— cow Piiltwint 
•ad ynilBn Opwrtow. 
Tr, Am. Latymgoi .In , 
WaaUagtoa. 1016. May. 

The author reports the case of a man. forty-two 
yaan of age. who gave no aubjective qmpCooM of hb 
grave condition other than naaal stoppage. Ex- 
ophthalmos was marked, deviation of septum com- 
IMetr, potyps in the middle strait. On account of 
acutr cJUKcrbation three davs later, the Loc-Cald- 
wrll operatkm was performed and extensive esenter- 
;ition of ethmoid bone, with wbddence of symptoms. 
Viw days after this, ssrmptoot returned and the 
Killian operation was done, with perfect functional 
and cosmetic results. Eleven days later an abscess 
formed in the cheek and was evacuated by incision 
bdow and parallel to the lower eyelid. There was 
peat distention of the chedt. frequent spontaneous 
mrmorrhagei; convincing radiograf^ and wooden- 
Bke hardness of the mass in tne cheek suggested 
sarcoma. Two months later, operation revealed 
an immense collection of true cholesteatoma. The 
odor was overpowering; all the bone above, bdow. 
and on each side of the mass was eroded and totally 
destroyed, inchMfiM the floor and inner wall of the 
orbit, two-thirds of the malar bone and all of the 
ouirr wall of the antrum. The pment condition of 
the patient shows marked a^* <<ath is only a 

matter of a short time. tuberctdosb, 

malignancy, were all czdudeti. Orro M. Rott. 

THROAT 

Thciaen, C. F.: .\n Epidemic of a Severe Form 
of Acute Infection of the lliroat. with Abaceas 
Formation: Report of Fifiy-eitht Opcratlona. 

Tr. Am. LAirymtoi- -tn , W .i«hin;:t.>n. it) if., .May 

Of JS4 cases coming tinder the author's pcraoiul 
observation, 58 developed abscesses in different parts 
of the fauces. Of thb number 44 were more or less 
tjrpical cases of peritonsillar abscess. Of the remain- 
ing 14 cases a b scesses developed in 8. in the lateral 
columna of the phaivnx. There were 3 cases of 
injection of the epiglottb with great rrdema and 
acme pas; 2 cases of abscess of the lingual tonsil; and 
> of retropharyngeal abscess. Joint complications, 
acute rhinitb and polyarthritb occurre«l in 12 cases. 
A<u-c endocarditb in i. and in 24 examination of 
t \u urine showed the presence of albumin and casts. 
In 68 cases acute otitb media requiring incision of 
the tjrmpanic membrane developed, with one mas- 
toid complication in which the membrana tympani 
ruptured ten days before the author was called. 

Cultures taken during the epidemic showed 
streptococcus infections in the majority of the cases. 
A few were pneumococcus infections. 

Orro M. Rorr. 

Iglaucr. S.: A Simple Method of Flsatioa of In- 
tubatloo Tubes. L*ry»ton«^. igib. tt>i. io8g. 

The method devised by the author b a modification 
of Rogers technique, and b cspedally adapted for 



cases of laryngeal ttenoab, which in the courM of 
treatment h :ired a tracheotomy. It nuy 

abobewed. abated patient by cutting down 

through a few uaiheal rings onto the intubation 
tube. 

The technique b as follows: .\ shallow groove b 
filed arovad an ordinary hard rubber intubation 
tube jtist bdow the swdl of the tube. Into thb 
groove a silk thread about ten inches long b firmly 
tied, with the knot on the anterior face of the tube. 
The ends of the thread arc tied together and the thread 
and groove are saturated with mdted paraffin to 
remove all sharp edges. Intubation b then per- 
formed in the usual manner. .After intubation, the 
silk thread b picked up with a »tenUer forceps (or a 
crochet needle) and drawn out through the tracheal 
fistula. The thread b drawn fairly taut and fasten- 
ed to the skin with adhesive plaster. 

Orro M. Rorr. 



Roost. F.: Eodoacopic Surgery of the 

and Respiratory Tract. J.Lamtet, 1916'. navi. 
♦45 

The author gives a xhtuxmi of the conditions for 
which endoscopy b of value naming the following: 
I . Foreign bodies inhaled and swaUowed. 
3. Laryngeal tuberculosb. 

3. Diseases of the larynx, malignant and non- 
malignant. 

4. Stenosb of the larynx of the trachea. 

5. Diseases of the oesophagus, stenotic and non- 
stenotic. 

6. As an aid to the intembt in making a general 

Orro M. Rorr. 



Auwerda. J. C. M.: The Toosib. Utd. Timut, 1916. 
xliv, 24i. 

Several diagnostic points of importance are men- 
tioned l^ the author. In the first place bdore de- 
ciding that a normal appearing tonsil b not diseased, 
the author mentions the simple expedient of w^^g 
pressure backward and outward on the anterior 
pillar and thus frequently a considerable amount of 
cheesy material, previously unrecognised, can be 
e x pre ss ed. Secondly, by pulling forward and out- 
ward the anterior pillar, the anterior fossa can be 
exposed. Thirdly, the author mentions the im- 
portance of the cervical lymphatics as an aid to 
diagnosb. He <ksaibes the course of the lymphatics 
from the tonsil to the superior deep cen^cal nodea 
under the anterior bonier of the stemomaMoid nma> 
de, and states that they receive thr" '«from 

(1) the tonsil. (2) base of the tong.. >m the 

submaxillary and submental nodes. 

In contradistinction to thb anterior group, are 
mentioned the posterior group which lie den oodcr 
the stemomastoid or along its posterior border. 

Ealafgement of these 1.1' lot indicative of 

toMiOar disease as they rt .r aflerenu from 

(1) the superficial nodes in ihr lubocdpital and 1 
toid regions; (2) from the rrtraphniyi 
(j) from the mucosa of the pharynx and 1 



Si 



DfTBRNATlONAL ABSTRACT OF Sl'RGBRY 



t 
t 
i 

4 

$. A 



Iqpt. «Mci it pwlw i to tlM 
lortktMMMiMMM: 
li cwBpMdjr mmtkmm i&t loaril 
It tak«i Wm da*. 

Tlw pufat hmIim hm iMwillnic, 
TWm li l«i uiMMilia. 

of lovBi CM be 




ol All toMtt Umm ia 

t# tIriH lOplkMiOMi fflfWfl In CMM of MMBi 

k pmtakM of IW tknm Mlare. TW atllMd 
ploytd b 19 MfMiu aiwnd Um i 
Um Biliiadt— , PC 



Orro M. Rorr. 



i«i6. May. 
tkod W vWcii tW 

iMMMld UMI Mid 



T.ltiTW 

«f 
fr. .4*. Ltrym§d, 

TW mmImt 

CSt«Ml 

(oribri 

liom Om IhiI •! tkt hijiaritil 
■ow «Md for tiwiy of iIm iomO M a 
ahvopsadoM. oMjr bt VMd for diioct toMOIoMpf 
or for tW caadaoUoa of tlM tooafl im siim. TV 
faMfodactka of tW iaottaaaat iaio the throat b 
bjr aiiac tbe dMrtoM of the Joduoo 
I witk a MvoM oad aad a bmp oo a 




to ilM palaia^oMMi pontilor to tJM pilitapha- 
aad tatoraal to tko ta-cilltd amdo, oaet a 
for fav voriuk la aioMlioaal caict iUhc 
A Mtt appttratkNi of 
pw c o d ti tW fidpiiilioa ia paisiaift who orr 
•Miillvr 

Tbr adviniiaM dalaMd lor ilUa p ro codaw ara 
tlMt b b aaf«; tWo b ao Ioh of blood; tb«« b ao 
•car tbaao; U BMy be Moppod aaywberr tboit of 
I orodbnina; tbwa b ao iatorraptJoa to the 
'• Tocadoa. Orro M. Wart. 



«cafibr of tbe aot lugHl taba. packed aecurdy 
fUM ao tbat tbe laM b biM Ja« witbin the 
dblal opcaiM aad tbe eadol tbe tabe dipped bebiod 
tbe toadL la tbb way tbe toaaO b Uttad ap aa 
brppeal^y at la tbe powerful atorauapMntai. 
the author boa ataofed tbe 



I. C.W.t Abaoaaa of tho Loot —m 

Oparatlea oa the ToaeOa aad Upper Air Tract. 
Larymjttnpt, 1916, nvl, looi. 

Tbe report of aiae caaea of laag abaceai folbmiaa 
toaaOloctoaqr ia tbe BMdlcal ward of oae boapbal 
witbiaavear aboald oambarfM tbe fact that taadl- 
lectoaqr b aot tbe lifl^HO aaiiical p roce dar e tbat 
tlie laity aad many iateraiata aeem to coarider it. 

Tbe cauae of paltnoaary abictai — '"'■rff y to 
tiWMlllertnniy b probably tbroogb eaibol b n i or 
iafocdoa of the loag. liaay veiaa are opaaod at 
operatioa ia the preacace of lepiif auuorud or ia- 
foctod Mood, or piccco of toaa&lar tiaaae auy be 



tC' 



ted. 



to 
beahbfai 



iadudinjc jjj 
a lane but 
of yoatba aad odalla. He coe- 
chrfaa tbat whBe tbb any aot pcnait of deiaUe 

m^Jk ^^^fel a^^ifti^p#^M^ ^^i^^MA^^^^A *Wa ^^^^Jaa 

ViB ■■■! WQBCIOTf OTWnBBBBB Ulv raBUU 80SID 

tbat tbe cntwhOe ealarfed toaaOa of 
Mhaad aHjr bo TCftrdod aa penaaaently 
If tbeycoatlaaeeala^BMl after tbeaevcath 
or otablb year, aad tbat tboialiiiidlnaribof health 
whicb aatafo a latrograde aietaainrphiab ia late 
cbBdbood aaqr iHMia the tOMlb of beahb. 

Tbe aaaaaiplioa tbat the toaaO boa ao ^ledal 
faactioa bccMM It baa aot ytt boea dboovcred, b 
aa M B I iiai i ioai ooafearioa of iayoteafo to which 
few coald agree, bat oae cnartarfoa reached In ihb 
aiady b that tbe faactioa of tbe toaaO b a aciriigibb 
featarr, for it OMM be coaoedid that a toaaO wWch b 
catcaaboly dbeoeed woald probably be the potential 
or actaal aoarco of too aaacb adicbicf to be offset 



author reports three caaea ia which he per- 
fonaed toaaflloctoay in adulia where polmooary 
abaceaa deyelo p ed ten days aft^ operatioa. 

Kuaa J. Pai 



bjrtbevabwofaav faactioa which a part of it michi 
Wbea, however, a toaail b fooad to be 



it dMald be left at leaat ia part to perform 
whatever faactioa it osay have, aadabolacMeatiBy 
to van tbe faacca the aow coauaoa peotoperathro 
aad the coaiiqp«M la i ^ g al ra i e at of tbe 
Bica* Ono M. Rorr. 



Lynch. It C.t A RJayit of My Ymt's Work with 
flaepeaeloa Laryngoeoopy. Tr. Am, U^yrngtl. 
At$., WsaUagton. iQt6. May. 

To prevent fracture of the alvoolaa the aatbor 
placea a atrap under the ocdpot and danpa it iato 
tbe aagica of the pcar-«haped riag, tbaa rdieviaf 
the preaeare of tbe tooth-pUtce aaaiait the toMb. 
In order to provoat otba* tooth tajatba, he aaea 
drntal impKarfoa ipooai illed with mnnWiint com- 
pound whidiofferacoanleleprotectiao to the teeth. 
tariMtatea the introductkm of the spatula, and makes 
it eaoier to keep the spatula in the middle line. 

The table, which b deacribed. cmn be rabed 
twenty inches, the lop can be tilted and can be aaiv- 
ed in a drrlr. Therr are foot- and shoalder-bracca. 

Regarding intrinsic epiihelioom of tbe Uryax, 
tbe a ath o r a eiperirace baa beea eacaptioaally good 
with eadolaiyagaal rrawval, bat be foab that bb 
b aot large eoongh to reacb daJaiie 



to 



A. M.i TaaaMoctaaqr. J. OpkA, ir 
tot*, a, se*. 

b the metbod daKribed by the author 
t nn ri H a r tiaaae. He dafaaa tbat there 



Diaaectioa aader aaipearioa b aot dificab 
cui be doae adtbaal ponahtlag oa iaatnuaeat 
toacb tbe taoanr tmm, 

Niaauea cMea of pap B l o aM i have boa 
faly opTOtod, dbaediag wii below tbe baae. carrt- 
tiM,aaMl paiaibw wilb alcehoL 

^sdaacalotod geioaM« vocd aodaba. a cyet of tbe 



SURGERY OF THE NOSE, THROAT, AND MOUTH 



«3 



arytrno-cpigloitic fold, psdqrdenBk Uryagitk. 
prricboodritk ol tW tlnrraid. fractare of tht thyroid 



cartiUflt, tnbofcakr Mrymitk, afaoccM ol the 
f pigMlW^ aad fofdigD bodiM in tbe tnckoft 
oaoplMfw wtn aD carad for by mnm ol the n 
poMon appontus. Orro M. Rorr 



Rof.D.! IpiOMttomoofrntoriorPhiwyi^AlWall 
Giwod with cbo Ilictracaocarj. Tr. via. 
Ltymftt. An., WMhiaftoa, 1916, May. 

The author't case, a fmale. afed 27 yean, waa 
fint Men July »o. iQiJl- Her previous and family 
history were ocgativr. Fur ihrre months she had 
soffercd with a sorcncas and throbbing in her throat. 
She had been treated continuously without result. 
Fwminatton showed a rounded uker 00 the poate- 
rior phafynfleal wall at the center, one-half of which 
was Uddca by the soft palate. It was dirt v grayish 
in apcarance. with edges sharply defined ; atxMit one> 
hall inch in diaaeter, and extending as deep as the 
superficial a p ooe ur o a is. A piece excised showed it 
to be an epitheHona. 

Removal was effected by means ol the electro- 
cautery point, wdl outside of its edges. No reac- 
tion and no discomfort followed. Healing was 
perfect under one application. After three years 
there arc no sins ol a return. 

Unfortunatdy. clinical observers are too prone to 
classify all malignant growths of the throat under 
the general term cancer, without distinguishing 
between tbe different forms of carcinoma and sar- 
coma. This statement is made because the author 
has found it almost impossible to correlate all cases 
recorded, in that many of them were reported in the 
most unexpected places, and not under the headings 
where one would expect to find them. .\s Morell 
McKemie and others have pointed out, the disuse 
b often so extensive when first examined that it is 
impossible to determine its point of origin. 

Textbooks are very vague in the discussion 
ol this subject. It has now been three yean since 
the case here reported has been healed, and there 
have been absolutely no signs ol a recurrence. 
The results obtained in one case, especially of the 
cancerous tvpe, certainly do not justify any positive 
deduction, but the author believes that the thorough 
and judicious use of the elcctrocauter>' offers the 
best chance for a good result. Orro M. Rott. 

Bryant. W. S.: The Clinical PouJMimea of the 
Phail llgial Pt t u I c ar> ; an Account of the Clin- 
ical R alati oo of the NatophaQoa to the lly- 
Sy st em, iltd. Kte,, 1916. sc. 441. 



The author's intention in this paper b to show 
(1) that the hypophysb system may be affected 
clinically through that portion of the system lying 
in tbe nasopharynx, the pharyngeal pituitar>'. and 
(1) that the results of clinical treatments ol the 
pharyngeal pituitary are similar to those obtained 
in like conditions by hypophysb m ed i calioo. 

In order to iUusirate thoe points he diiruiifi 
<i) adenotomy in its reUtion to the pharyngeal 



pituitary and the hypophys b system, (a) certain 
poatnssal treatmenu whkh Infmence iIm hypophy- 
sb syston by way ol the pharyngeal pituitary . dain- 
in|{ that the rcsulu after adenotooy and ch—ical 
stimulation of the pharyngeal tOMO, maniftfd by 
rapid growth and impnmn nutrition, by reUel from 
aprosexia and morbid iomnoleaoe. bv freeing the 
system of infection and local relief from pain, 
bv the regulation of blood-pressure, of pulse, ol 
ctrcniation, and of temperature, all speak for 
themselves as to the involvement of the cerehml 
pituiury in the renewed activity of the pharyi^eal 
pituitary. Orro M. Rorr. ' 

MOUTH 

Moorehrad. F. B.: Tbe Prevalence of Chroalc 
.Mouth Infectloos and Their Manatemcat. 
J. Am. i/. Alt., 1916, Izvii, 845. 

The finding of evidence ol chronic OMUth lesions 
in 6q to 89 per cent ol a group ol 700 carefully 
analysed cases b convincing evidoice that, regardleBS 
of the form of treatnaent emplojred, the removal 
of infection b imperative in all cases. 

In carefully selected cases, conservative meas- 
ures diould be employed both in the treatment of 
chronic abscess and chronic suppurative pcricemcnti- 
tb, thotigh the involvement 0^ the peridental mem- 
brane b the crux in deciding between conservative 
and radical treatment. 

Faulty root-canal technique, the careless use ol 
arsenic as a devitalizing agent, and irritating drugs 
used in tbe treatment ol root-canab are strong pre- 
disposing factors of chronic alveolar abaocss, and 
where root-canab have been treated, the process 
of repair should be checked up by roentgenograms 
at frequent intervab. The roentgen ray b para- 
mount both in Hisgnosb and in determining the 
extent of tissues lost. Etutif J. Pattcssox. 

Braun. A.: .\cute Infcctloua Procesass In iho 
Mouth and Throat. JmUnm. J. Smrg., 1916. zxix. 

The suthor mentions as the commonest ransci ol 
throat infections the following: (1) streptococc u s, 
(2) staphylococcus. (3) pneumococcus, (4) diphtheria 
bacillus, (5) bacillus fusiformb (plant vincent), 
(6) bacillus mucostu, (7) bacterium coll, (8) ^^^^-^df— 
tetragencs. 

In spite of the different cerms giving rise to the In- 
fcaion. the same patholoBcal process b produced by 
each, the only difference being that usually one phe- 
nomenon b more prominent than the other, depend- 
ingupon the location and the infecting agent. 

The following dassificstion b given ol inflamma- 
tory processes in the throat, depending qion tW 
location and which symptom of fnflamwation ia 
most prominent: 

I. InfUmmatioos which occur chieffy in the mu- 
cosa, ol which there are four types: 

(a) Erythematous type, in which congestion ia 
the predoHMnating synpconi. 



INTERNATIONAL ABSTRACT OF SVRGKRY 



of wnum ftd cdb. mmw, or wiritt cvlk 
it) DipMntNt ijrpt, la vMdi iktn mmy bt 

tally «r IqrtlM dMnmtioA of Um ipitlMlial la^ of 

lit waBOM. aiMCMtcd villi woriea ar ahataitoa. 
(W) PIbtteaat typt. la vMdi Um aradau Mraai 

catgalaiat. fonalat a wmtknm aa tlw taifaet of 

f . talaaaMiloat wkkk occar cMdly ia the Mib> 



of wWdi UHfa aia tarw types: 
(«) (gilianiaui typt, la wMdi tnidiiloa o( 



•ctaai Umo iIh 
pw i l iiaii a i i i 



caaaecthrt ti 



bike 



ik) riMik laliUMiiv type, la vUdi iha asoda- 
lioa of vUucaBilate tie eabaMwoai o 



tbmr b tkt pmWiailaiHBg qraiploai. 

U) PMnainaniM type te wWdi tbiia b death of 
the •absMMaae coaaemvt tbeae with cndatee of 
«Mi* cdb lonaiaf pai. 

TW aatbor dbcaiiet la deuO the 
iaiiBiBiiiinai; (t) faadal periu 
(f ) Sagaal piriioaiBier ihetMi, (j) lalfopharyafeal 
ebtHi. (4) Ladvif'e aaflaa. Orro M. Umt. 



Myera. II. B.i Oral laf«ctloo In lUlatioa to Sf- 
leaiUc lafectleae. l/<V C^mmil. 1916. x%i. 35. 

The author givca a lieaai^ of the qucetioo, dbctt»> 
dag the BMide of origia of qrMcaik roaditiom froai 
laaMie fod. drawiac aitcation 10 the fact that three 
foH are oot awtdy pUcet of eotraace for bacicrb. 
but art place* where coaditloae are favorable for 
thoB to acquire the propenie* which give them a 
wide raage of afiaitira for vaiioaa atracturca. 

Om> M. Korr. 



B. B.t P eat al lafectloaa aa 
aaae: TVMtaaaat and Raealta. 

1016. Uvfl. 8$i. 



J. At 



Dla- 

.4 If.. 



The rrtogniikw by the dcotal aad awdical pro- 
Irarinni of tar important rrlatioo of alveolar abeoeaa 
to ayn e iak dbeaan, doe largely to the perfeotlag of 
ipMc technique, rrquim tae rradjost- 



af pfacike aad aM hod* af dfagaaab with aiaia 

•wan tmaeea deaial aat^Ma aad phyaidaa. 

Theft ieea» to be ao qaeeliaa that alwidir 

aMy be the eaarce from wMdi iavadbif 



M paaa lata the circulation prodadag bm- 
taalalk liaieai, or they auy be lateat ao far aa 



autf had e lect oa the gaaeral heahh 

Newfiaeieea« taey are 
aad from both the OMd 
ahould be eliadaatatL Adeoaala wT gif i l tiaati 
carried oat by the dealbtyiilde the beet 

J. Pa 



of trouble 



Garaaady. T. K.t HareHp aad Gtaft^alata. 5m<*. 
U / , 1016. U. 744. 

If there b a complete deft from Up to pharyax 
the author adviaca the faUowing order of operatioos: 
(1) hard palate by f ordog auperior nuudlbr to- 
gether aad preauunlla iato aorauil pfftjtfffn before 
taeeadof ihelhird aMOlh; '" ■*- second toaiath 
mooth; (j) toft palata— ail coth month. 

The technique advbcd b> i.i^,^ b p re f e r red for 
hard palate work and that of Owca Siaith (or the 
hardip. while Laagenbcck's method b advocated 
for ftoit -palate work. Orro. M. Rorr. 

Stent. P. 8.t PortlMr Siwdy of T^wien of cbo 
Uvula GoMldoefai TiMb' Preqiiency. MaUg* 
nancy, aad Racurraoce. Ltryuiftt»pt. 1016, 
iivi, 1075. 

The author preaeata caae reports from the . 
ture and givea the foUowiag aummary of hb Mu<i> . 

There were g caaea of cardnoma; of thcae a 
recurred. Of the q caaea of epithelioma reported, 
J rrcurrrd. (M 10 caaea of papilloma there were 00 
recurrences. There were it other caaea reported 
without any data. Of the fibronu there were but 
i case* reported with very incomplete data. 

No mention waa made in any caae of treatment 
with radium. Once a caae of cardoooui waa treated 
with X-ray but the outcome ia not known. 

Orro %i. Rorr. 



BIBLIOGRAPHY OF CURRENT LITERATURE 



GENERAL SURGERY 



SURGICAL TFXHNIQUE 



Nors.— The bold fan figoNi la hmduu at the right o( a refercnoe 
abatiact ol the article reCcrred to may be found. 



Opcmtlv* Surgery and Technique 

Lack of team-work in the operatinK room. C. N. 
CnniAX. Vlfg. M. Scai-Monih.. 1916. ui. tjt. 

The aanlkatloo of dro|>-aicaMiriaf( to the Wtdal tech- 
aiquc. E. W. A. Walkuk. Lancet, Load., 1916, ctd. 

(Darfaohydfatc feeding in wtrgkal caaei. A. McQinucirBY. 
Am. J. Suff .. loio, sxs, J64. (1| 

The txaoapUatatioD of colored stripa of faida lata. O. 
Urrarovm. g|wiinwmik, 1016, In, ^1. 

The prsveation of obrtniction of the pa«age of gas 
foUoviag operation on the colon. A. J. Oobxck. J. Am. 
M. Aaa.. 1916. Uvii. 483. 11) 

Traaavcnc iadiioaft in the upper abdomen. A. V. 
Motaoomtn. .\nn. Sunc-. Phila.. 1016. txiv. 368. 

P iwa nU we treatment of postoperative pentooitls. 
OufOic. PrHM uM., 1016, p. 305. [2] 

POMoperathre inanity. \V. L. Skcok. Texas St. J. 
Med.. 1916, xii. 2io. 

Poatopcntive treatment in rectal suncery. \V. H. 
STAirmui. Proctol. k Gastroenterol., 1916. x, 137. 

Aaeptic and .\ntlscptic Surgery 

I>Uinfcvlion of thr htmi^ \>y the earthy hy|K)chlorttcs. 
DiaARD. Hull Aia'l >iv nunl.. Par., igio. Ixxvi, ijj. 

The use ul ptcrk acid in war surxery. T. F. Bkuwn. 
Lancet, Load., 1916, cxci, 433. 

Note on the use of hypochlorite of maxoesia in surger>'. 
M. Dt'B.uu>. Bull, et ro^m. Soc. de chir. de Par.. 1916. 
Ixxvi, i|4. (2| 

.\aepsts or antisepsis of fresh wounds. A. Hamm. 
Bcitr. x. klin. Chir, 1016, c. Krieft«:hir. Heft. ti. (2) 

Anaathetics 

GcBcnd angitheria by direct intubation in opera tiooa 
upon the head aad iiedu Gtnsu. Bull. .\cad. de m6d., 
ru., 1916, Ixxvi. 245. 



Indicate the page of thb iaeueoo wfaicfr as 



R. C. 



Alkaloidal adjuvants in general 
CoatniN. Med. Rec. 1916, xc, 460. 

.\ccidents during and follotrin^ geaerd 
I. C. HcKB. .\m. J. SurK-. 1016, zzx, J97. 

l>eath after nitrous oxide-oxygen and ipinal anwtharia. 
W. K. R0BIX8O.S. Brit. M. I.. 1916. ii, >9i. 

Local an—theiia. L. K. UAtuHctTY. J.-Lancet, 1916. 
xxxvi. t44. 

Local anesthesia in minor surgery. C. W. McElhaxkv. 
Penn. M. J., 1916, xix, 904. 

Narco-tocal ancsthcaia in surgical work. R. E. Fakm. 
J.-Laacet, 1916, xxxvi, 499. 

Increasing usefulness of nerx'e-blockinit or regional 
angsthesia. A. O. Sixuucton. Texas St. J. Med., 1916, 
<ii. I9S. 121 

Surgical Inatrumenta and Apparatua 

Use of oerforated ccUuluid in the dreukinx uf certain 
wounds. §. R. DoOGLAS. Lancet, Ix>nd., iqi(>. cxci. 55S. 

A wristlet ligature holder. P. P. i'nur. Brit. .M. }., 
1916. ii. 329. 

.\ simple device for locating foreign bodies in finger*. 
K. C. WcBB. J. Am. M . .\as., 1016, Ix^ni. loig. 

.\ cysto-urcthraico;)e for dia^no*i« and therapeutics.. 
C. Mobales-Macxoo. .\. V. M. J., iqi6, civ. 600. 

A simple apparatus for the treatment of incipient hip- 
joint disease. G. G. Speer. Am. J. Sunt.. igi6. xxx. 30>. 

Provisory immobili/ation xfiparatus in artiiniiar and 
juxta-articulation injuries of the lower limb. L. Cuiarv. 
Paris tntd., 1916, vi, 3^4. 

.\ leg -splint with adjustable foot -piece. J. W. Wauub. 
Lancet, Lond.. 1016, cxci. 4S0. 

.\ new spine brace for the rotation treatment of tcoliosia 
and for otner purposes. H. W. Orb. .\m. J. Orth. Surg.. 
1916, xiv. 496. [3] 

.\ pneumatic crutch-top. R. C. Piebce. Ijutcet. Lond.. 
1016. cxci, 43o. 

Wrist-drop and foot-drop apptiaoces. R. \%'hizklaw. 
Lancet, Lond., 1916, cxd. 534. 



SURGERY OF THE HEAD AND NECK 



Head 

Three cases illustrating the functional conBaqaencei of 
head- injuries. T. K. IIarwuoo. Lancet, Load., 1916, 
cxci, 431. 

Case of complete avulsion of the scalp. E. Adams. 
Intcraat. J. Surg.. 1916, xxix. 316. 



Present sutus of carrinoma with spedal reference t9 
the head and neck. J. C. BacK. La r ygoecepe, 1916, 
xxvi. iicS. 

Mixed tumon of the face. M. ?AV%. Tr. XI .North. 
Surg. Cong.. 1916, Goetebofg, July. W 

Injuries of face and jaws stistained in war. M. Roy 
and P. MABTixtxa. Ann. diodont. 1916,1, 143. (11 



85 



I 



96 



INIKKNATIONAL ABSTRACT OF SURGKRY 



fton. t«»<N klM, «l«i^ 



Sl«4y •■ IW IliMil giMd. G. taMM. Wv. lUl. <ti 



..vie . 1916. It. fCt 
K J llr 




"%: 



to 



■Mkr bone •• 
A. McCov. l»t«nMi. j. 




Aaa. 



idhiyNflflB. B. 
fw.. 1016, dH, tM». 
cwiikitoi of Um )•«• hi WW womiI. 
'tidP. RtAU AaB.diotfaM . ioi6. i. 54< (1 
for Uw If fl «f incittml >•»«. A. C. 
BrtL J. amt^ t«i«. hf. ft4. 141 

Wmm •! t«« CMM « Inciwt of tW 

•«i6. nil, at; 

WM of cuew «f Ikt l«i|M ud oIUm leor ol Um 

C.B.8a«n. Oifclahgh. Mtitiid. toi6. or. sy. 

lioAtBHoi of coMnilsl ■ocraAoariA. if. 

MtruiJut. narin ImL-mSLIiiiiJL, i9i^Miri*i 

PuadMiol MdnoeudMaML AOaumou 
Madrid. 1016, nv, ma. 

of tko 1^ (towul lobr. 
TvniM wad Bovoouqck. 
1016. InB, 474. 

of otoMMW obKOM la twawwl 
loboL N. AawMMW. 9V0M. LaA.-8aribk. HaadL. 
t9t«jjdll,667. ,_ , 

BMriMi. Sl W. HoaaoK. Vlqp M. 8—1 Moalh . 1916. 
Bri.a«6 
SoawcaMiof oaaialvarMHMy. R. Moan. Gait.d. 
0d.dhL,Mlaa0hMi6,niva, ttiOL 

rib of oari 
Dboodi. J. da grid, da Hnwteaai, y 16, wnni, m « 
■oBMMi woaad dMoisnr oonaclad Inr aillipatiow 
of tka MU» aad ^'*^»— traMplaaialioa. H. Moaami. 
, at ate. Soc^ddr.. Par, 1916. lii, ti86. 

wUk iwriidtir iMJoa. A. Cabum. 
1916. Us. 419. 
TW opantiva liMlait of oaaial gwMkac lajariM. 
F. Mcsuas. Brill; a. kla. CMr.. 1916. c. KifapcUr. 
Halt, 74. 

SMkal tfcatant of liactMW of Ika vaak of tlw rinriL 
E. T. Nawtix. Ilanitt. J. Sam.. <9>6- ulx. >8 1. 

aainrrita a' -na. B. 

tawlCAEunM. N.Y. M. J v. 6^3. 

f llM latanl vaatflda is Ika andoi«ed fona of 
Ncvm-UniAiaB, 

Xfi.''k C. 

M . ., 

Uaanri caia of Igidniiaiifcriai R. D. Morfarr. 
ArIl ^idki^ 1016- nxffi. 690. 




Baria fa^lailaK. B. F. Ztainuutui. Aa^ J. San.* 
191*. m. •S4. Ml 

A CBH af aaitiri aiipwcarad atlar anacliaa of tta 
lauaoaiabval paalacliik n. Ama aad B. Pnm. 
pMpii aridn taift. P^ *'T* 

l^lnv tma fUoaa of Uh btala. O. B. Kn*4U. 
laMm^ J. San., ^rt^aab, jtf. 

Laflrihaiiaa « CMMMT taBMi— Ika aaalri aarww 
B. O. Oaav. BriL Jakaa Raplkt Banpw, 1916. ssvi, tft. 



A lapart of Mvaaty caas af hnia laaer. G. J. 
aad W. B. Dakpv. BaB. JoIum HopMai Hoip.. 1919, 
aavU,*a4. M 

Claal cril itwa of iht tuain. Watoamot. Piatiai 
and. Wckaickr.. 1016. xlU. 1177. 

Rapact af caia of BioMioMaa af aaoaala BfiaiL AH. 
WanB. PlidicM.T7t9it.ls.fM. m 

Ffbnmmmuoamm of iIm faiaia. D. Qoaoa. Aa. d. 
ham. da aaa Joii, 1916. I, 19. m 

Coiabtal aaaiaHMi ceaaaaaaat oa iIm l awa ti aa af 
BwariM lajafy to tha caradd artariai. G. H. MAnaa. 
Laaeal. Lead.. 1016, cad, $45' 

CaiaiMal haraia. MAaraoa. Plana arid.. 1916.^ 

TW pkaiiarjr body. I.G.Coa8. Mad. Ptaa B Or.. 
i9t t,«. t ^ _t^_^ 

Rcpofft of Monan of a caaa of pttanafy taaav lapoftad 
ia 1014- T. If. HAiaTKAO. Vbf. M. Saad-Moatlt. 1916. 

Nacfc 

Tiaiuaaa of tbc aock aad mjaa 
Gjraac. B Obit.. 1916. xdil. ut. 
of tbe carotid body. 



F. E. 



R. Wucatoar. Aaa. 



Sws., PUU., 1916, Ixiv. asj. 
Carrlaona of l)inpb nods. 



Sm.. PMbi, 19"'. Isiv. 355- 
Tim «fi aMOAgcmcot -^ thvt.M 

lodiaaapriii M. J.. 1916. 
Tba feitar ptoblcra. U 



J. A. HAaTWKix. Aaa. 
«ai«. L. Lnai. 
davriaad M 



\M. 



1916. IV, 4i5. 
Toak tatter ia 



Ha 

giri tea yean old. A. W. SAonraa. 

UL Suff.. Phfla., 1916, lihr. 371. 

Giavaa^diMMa. C. H. JUoam, N. Y. M. J.. 1916. 
ciV457. 

nMaf ia tbe t^Bmim can^ iyHipathatfc IMiBa 
raaaavad lor the rrild of aaopalMlaMi. L. B. WBmm 
aad L. DtmAMTa. J. Mod. RoMaicb. 1916. saihr, rts. 

The otiolagy aad tiaalaMat of aaoBhUMlaric arilar. 
with HMdal idwii to the aie of lattaak W. hTb. 
AtKorn. Mod. Pnm k Or.. 1916. di, tyi. tfM 

Tba tiaatiaaal of eaaphtbaladc fritar by aMaaa al 
tbe raeatapa ray*. G. E. Ptabub aad J. D. Zoucs. 
Poaa.M.l.,i9i6.da.«6i. (11| 

RiMdla of cuiaiatinai lor aanhlibaiadc aeter. B. 8. 
JuBO aad J. D. P anaaa rcai. lied. Ptaia B Cbc, i^d^ 
dl. Its. 



UJl 



SURGERY OF THE CHEST 



Chaac WaB Mri Bfaaat 


PMri'i diMata of tba akpla aad caadaoM of tba bf 
wRb ipadri ufataaca to tbai Brti ■! iMlaiM iail iialbii 


laladM of Iha cbal dariag erar. R. M. Lano. 
N. Y. M. J., i^tdu chr. 6*t. 


oftbaciaJHiB J.CBvnii. BdMk M. J.. •9i«. 
161. 
Kolai oa a cMa of caidaaaM af Ibi awla faroHL 


alBfi. BD.BnaB. Laaod, Lead.. 191*. cad, 477. 


RacnaaiL Mod. J. AarinL, i9>t. H. »S. 



BIBUOGR.\PHY OF CURRENT LITERATURE 



87 



H« fartarnwtufaf «f asviag Md b Uw i1m«u m 
^ ^**r"g^ B. Houm. Chkago M. R«- 

ladiKcd pMMMUMai m aid la Ibe Avdy ol i»li»- 
tkonck tioMini. jAOusAKt*. Loonugui, aad Kky. 
SvcM. Luk.SmML BudL. toi6. ilU. 1074. 

BradM plnwMivy. A. A. Law. J. Am. M. Am.. 
1916. tsvi. 1^. 

EstmeliM ol a mobOt brikt tram tht plMfsl cavity 
allw MUfalUuBcat of artflkW pMwaoChons. Gooil- 
uom aad Abckuk. Lyoa cMr., 1916, iW, 619. 

Estnplcural tboMcoplMCy ia pahMaary tubemikxk. 
P. BvLi. Tr .\I Nortk »0|. Coag.. Goetefaorg. 1916. 

Satgkal tnatowat ol chroak puntlcat plcuriiy with 
iMhL S. MxxDV. Torii, BaoM* Aim, 1915. 

ffayjiaM ia iaiaacy aad HriMhooH H. T. Nimurr. 
Si. PM M. J^ 1916. sviii, tjo. 

Eamvaa oiw to iafoc^oa by badlluf typboM» para. 
A. C C. Was*. Laaoal. Load., 1916, ad. 433- 

Danaoidi of tba aadlMliBaai. A. E. Hcanus. Am. 
J.M.Sc..tot6.diI.i65. (121 

Tracbaa and Lunga 

Ftirtber report on forrim bodim io tbe tradica, bcoodii, 
aad rfBOpbay. J. L Btmotsa. Toaa St. J. Med.. 
1916, lii. Ml. 

Impartod facdgD body ta tbe tiacbea. C. J. IicpcaA- 
TQBL LaryacoBoopc 1916, nvi. 1176. 

Tbe trcataaeat of tracbcal ttcn oa ia , G. HouicaKN. 
Svcak LadcSaeOtk. Haadl.. 1916. xlii. 1017. 

TkeatmcBt of foraga bodk* in the lunc. L Dnooor- 
Tts aad E. Pnaix. Lyoa cbir., 1916, nii. 590. 

EitiactioB of intrapalmonafy pwjectBci witb (orccf» 
oader tbe tcreen. L. P. DC la Viueox. Bull, et m<m. 
Soc de cbir. de Par.. iqi6. zlii. 1889. [IS] 

Tkaaawtic polmoaary tubcfoiloak. L. Giaotx. Proac 
mCd.. 1916. p. M4. (131 

S up iw ua t i oai of tlw luaf aad pleura with their suisical 
indicatioat. S. E. LAmntT. Northwest Med.. 1916. 
Jnr, asj. (13) 




I iimbildt of tbe loatt «<■•- 
J a maMfaaai camor. D. NAaooca. Gao. mad. dl 
Maa. 1916. dH, aj4. 

Sarooaw of tba nag ia the iaiaat. L C. NAVAsao aad 
I. P. GAsaAaAK. PraaM aiAd.. AifaM., 1916, iii. 7S. 

1141 
Priamry caidaoaw of tba hngk E. Soorr aad 
J. FoaMAif. Mad. Rac, 1016. ac, 4$!. 

Pibaanr hag lotaia at tbe froat. F. La xd om. Beitr. 
I. UfaL Ciir.. I9t6. c. KriegBcbir.. Heft. 1 1 1. {U\ 

PaaaaMCtomy. A. BvcAaoi. Toik. Boeaoa Aim, 
I9IS- 

Heart and Vaacolar Sfataaa 

Suture of tiie heart. RorarocBB. Daaticbe amd. 
Wdiaadir., 1916, ilii, 1086. 

Seoarate aod siandtoaaooi liaatnre of tba ooroaary 
artcnea aad vetae of tba baart. L. DoKKna. Polictta^ 
Roma, 1916. zziii. aca. cbir.. 155. [U\ 

Sbrapeel wouad of poeterior waB of pericaidiaBi. R. S. 
Snavctc. Brit. J. Suig.. 1916. iv, 96. (1^ 

Pharynx and (Eaophagua 

Stricture of ctaophagia. Hkmkbi. Daatacbe mad. 
Wchoichr., 1916, xlil, 10S5. 

Folda aad vcba at tbe ooper end of tlie cmaphaguiL 
R. H. Joai a row . Maiylaad. M. J., 1916. Ux. 189. 

Fordga bodiea ia tbe oopbogua. E. Bovo. Caaad. 
PracL m Rev.. 1016, xH, 369. 

Foreiga bocqr ia aaopMgaa ia aa tafaat fiftaaa aaabs 
old. wiccemfuBy removed by gaatroctomy. R. H. Cuhbt. 
J. Micb. St. M. Soc. 1916. XV. 417. 

Tbe fCBMval of foreign bodice from tlie omopbagui aad 
rmpiratory tract. H. B. Gkaham. Calif. Sl J. Med., 
1916, xiv, tS4. 

Opented case of idiopathic diUtatioo of the oaopbagoa. 
V. ScBALDKMoaE. Tr. XI North. Suig. Coi«.. Goetebot g, 
1916, July. (iSi 

EndoMopy of the cesopbagas aad upper air pamagm ia 
children. C. J. iMPcaAToai. N. Y. St. J. Med.. 1916. 
«>'>, 456. 



SURGERY OF THE ABDOMEN 



Abdominal Wall and Pcrltonaum 

.Xbdominal wounds in war. C. Wauack. Pncti> 
tioacr. Loud., 1016, xcvii. 901. 

HypctalgMia ta ahdomiaal diacate; prdiminary notm on 
tba dt ag an e tif value of amsfaaal poiau of byperalgHia of 
tba dda aad aubcataaaaai tteae of tbe abdomiaal vaB 
ia afcctl aaa of tbe ahdomiwai vixcra. D. Laur Prac- 
titleaw. Load.. 1916. xcvii. 106. (14] 

Ibbarcaloui peritoaitia. C. R. Hvoa. Am. J. OUt., 
N.Y.. 1916. ladv. 466. 

St r eptococcic pwit oa lti a caaipltrating cryiipdaa. G. 
M. Law». Aaa. Sam.. PUIa.. 1916. Ixtv. 379. 

Acute tubeecaioai pcritooiti*, peritoonl graaolia. 
A. CaaAixoa aad G. SccrtA. Rev. .\aoc mtd.. Aigaat^ 
1916. XXV, JO. (I7| 

Modera treatment of acute peritoaitit. A. Cm oaoi a . 
Intcmat. J. Surg., 1916. xxix, 145. 117) 

New nietliod of drainage in gManlMd pmilaaitiB. 
H. CaAKn. Paris mM., 1916. vi, >7j. 

TuiBiHiillwiialiiiliiiliyiterectomy. J.O.Po&ak. AaL 
J.Obat^N.Y..i9i«.lx>iv.7i. m 



'6! 



Eventration of tbe<Baphngm aad daatrocardfaL H. G. 
Wood. Surg., G^nec k Obrt.. 1916. xxiii. 344- (IS) 

Some obsetvatMoa oe lieraia in rdatioo to intcMmal 
•taaii. W. M. BcAca. ProctoL k Gaatrocstcrol.. 1916. 
X. 161. (Abstracted Intcmat. .\bs. Sun.. 1916, xxiii. 45^ 

Double ingutaal iMmia. N. K. BAao. 
Gas.. I9t6. 3d, jAO. 

Uterus and tubes coatalaed ia aa iagulaal bctaia ia a 
male. A. Bcivdcai7. Arcb. amaa. d'obat et de gyafe., 
1916, V, 150. jlSJ 

^^ f ^pnj j ^ f i*»i s «imI Mqucbe of tbe opentioa lor iagumal 
lieraia; aa analyrii of oae thoniBd ave b a ad i ed caam at 
tbe Mamacbusetu General HospitaL L Davs. J. Aai. 
M. Am.. 1916. IxvU. 4te. (If) 

Lbiectomy aad Hm b gical bemia. W. LAiaaor. J. Aai. 
MTAm.. 19t6.lsvii.487. (If) 

Epigastric betaia ia Scpoyv N. W. MAOCvoan. 
ladka M. Gas.. 1916. xi. j^ 

Vcatial hernia. A. V. Moacaoowm. 
Pbia.. 1916. Ixiv. 3/U. 

McMBteric tbromboria. 
Pbla.. 1916. bdv. 378. 



G. M. Laws. Aaa. 



88 



INTElOu\ I lO.NAl. ABMUACT OF hlKG^JlY 



Tract 



Atanr. Um bMk Imctt^ 



■%i'*M 



M. 8«Bt- 
R. Hun. 



•ad ■Htik 

Mipiiili Md ifnUMM «f pmImMmI pwuk ud 
dMdail i tet.^ O. P*Ttt. lUv. ntd. di I* Salat 




ft Sw, I*!*, nriv, 9%t. 

■mtTvifi M^SmdSlaatli. tot*, nl. a*t 

TW tHTt iMttlHttMkm at Ihc fMCffk Mii 

iIbk. H. Gt»ucBo. 1. Ttimi««sv. aad \\ . 



Otilfk 



NOOTM. WlkM 



J. Aa. M. Am.. 1916. lavtt. gqo. 
•ad daadaal tdow la tlw iw< 



. M. J^ toi6. Bv. It I. 
pHlfK iaov'4«i«ir. 



, UtI 

iwwinra* T* W • 



tnuHfiHioa; iMtvo^ 
Idv;j6i. 



V. 



fffoiB tuiwha l itaadlpoiaL 
BaadL. t«i6, dli. 



G. WoouBV. Aaa. Sunc . Pldb.. t9t6. 
ol ckfoak vkm «< dw 

TW ■wini»?*twalia?l* ulanillhili caioai alcwa of 
Ika ilwarirt E. Lns. Aidt I. UbTcUr^ t9i6. cvU. 

Qaslsic aa^ 
A. TteBU. 

Man rascal timtaMat ol tliindi— I aad iMtfk tdccr. 
J. ft. D&AVsa. Aaa. Sam., FMa.. t«i6. bhr. M4. 

TW vidac of voalsaMasr oaariMiioa la Um oMBorii 
af caacar of iko •totaack F. H. Baktju aad iTntm* 
BaVAiOw BaB. Jolf Hoalrlai Hon>.. tot6. pvtt« »i. 

The valoo of Uw oaaalilallvo dliaiaaiina of diiMlvod 
ifcaada la tW gtrtc cetla la Uw dhpori» of caacor 
of lilt rti— ill J. FlUBBCinrAto aad R. F. KatrruM. 
Am. J. a. Sc^ 1016. dB. 1*1. 

At— liBiaiiimotfcaaliolaiyofcaacoroftheiKindMtai 
aad fMiHck. W. Locbb. Sam., GyMc< * ObM.. 

i9td,BdR.4** 
A aw of aMbk caacar arBli nooaduy canbdiar 



D. M FoaSOKBT 

puljt. 




A. Cabc Proirl* add.. 1916, 

'. J. C JonooM. 

fa^a-MlanrtOTiy ia Y; 



'•**fc-- 



^t53 

of Um itoaMcli aad 
iMMi'aM. a W. Qblb. Botfile M. J.. 1916. ti^ 

'^DoiViBiialwMctlMHia. A. Wnsa. CaBf . StJ^ 

i9t6. tft, 117. lai 

of caacar of Um pyiaim. V. PAOcast. 






lBI< 



lotcnMl. 






J. A. li*Bi«Ki&. t-iaR. rmr^ . k umm., I9(6« ISiV. ltj|- 

Rodloladc dady la MaHToMOi of laladlail oUuac- 
Uoa. J. A. SMUtaon. Rov. Anc add., Aifm.. taii^ 

W. K. Galub. GmmmL j. M. k^ 



M 



t ;!'-. d. 



t 



\>ut« huawaiinillua (wilMo lorid duo to ii 
«riiiMiMBialodiaa. L.W 



wtihlailMl 

Aaa. S«f|.. PUb., 1916, Idv, 

VdvdiM wlUi 
onphalo-oatodcaa. 
1916, acii, adf. 



HcyioBBHa. 



F. C 
A 




MaBnaat tiaadonaatlna of baajga hrtllaol poorUM. 



cadtS'i. 



of ntpturrd Ocum aad bladdar; onowtioa; 
C. P. i': Wakkucv. Laaot. Load., 1916. 



CoMaaitd d i 4i^ tfM<ii?a aad rt d iiar t lo B a l lM t l on of Um 
caadaJ ioaia aad odoa. J. R. Eastiiax 



Aa^ 1916. lavU, 647 
Tat vakMof 



j. Aak M. 

m 



MdUpIt artkritk. J. T. 
t0i6. bvll. ;ll i. 



hret 
Y.. 



la Um tfiaUatat 

BoTTOMunr. J. Aia. M. .Vm.. toi6. 

A COM of carrinmna um ia • r 

yoan of afe. J. R > Am. J 

1916, Udv, jSo. 

ApptadidUi — a locoid of pcnoad cjqiefkact la 191S' 
A. EaamfiiBO. Aai. J. Soff.. 191^1 »>. »89. 

Pla wonaa at a cauM of a p | itwdlrilk . A. W. Aaa- 
•xaoiM;. N. Y. St. J. Med.. 1916. ivl, 47a 

A CMt of Uaiadaonw ia Um appaadb daidatiag 
acatoapptadldtb. S. G. Pat ABordotoa. Laacai. Load.. 
1916. cao. S'i- 

Biid-obot fouoH in thr apprndis. J. N. VAXOca Vcaa. 



N. Y. St. I. Mcti 
ilioa 



«u{icmrati%-c apficodidtk. 

tgio, dx,8jj. I3M 

M. G. West. Aaa. Soif.. 



J G. Sataani 



Aai. J. Sain.. 
A.M.9BoarAL> 



Prcvcatioa ci 
D. GonauB. I'' 

Saraaaaafti). 
PMa., 1916, Ish 

Actrte amadiiitt^ 
1916. an. saj. 

Wata loopontc ia 
TBB. Yin. MTStad-MdaUL, 1916, oLjte. 

ladloclko apptadlcartortta. RTT.iloBBn. Mod. 
Pnm A Clic. 1916, cB. 191. 

AplaaforaMialMaMappMidactoadaa. A. B. Gbbbb. 
Yin. M. Stad Moalfc . 1016. ad. »99. 

*Ti»^ff aad pathdoKKal acptcta of priaMiy MicoaM 
ofUMlaittlalartlor. (^ Porraa. SoatimoM J. M. ft S., 
191^ uiv. tTa. 

- ale lafoc 

J. M. Lvmgb I 



•oi*,B.j6t. lai 

ol pffatai lor alov. G. Wooubv. Aaa. 



Cciloalc iafocUoaa; aoaM laiafar ol 
aad W. L. McF. 
1916. IbvH. 943- 



'ablabd. j. Aa. M . 



by oaaaanraovo 
of Um 



IMBB 01 DM CBBpliai 



of Um 



C. A. L. Raaa. J. AaL M. Aa^, latd. Iwdl. 9t>. 



1916. 



L. C. M. Cnan. Idad. M. j.. 
i9i^aDnd,4^* 

DtcMBkattoaof ihtdaodaaaaibFilew. P. ■kiwbbo 
aadR.PAOMMi. Pmbm add.. AmaL, 191*. 0.47- PH 



tvpok 
Aia., I 

conoclioa of lataidauvo 

.A.L.Raaa. J.AblM 

RcBM««l of thr rifbt rdaa; 
('. II. Mavo j Am M Ai».. 1016. lavl, 779^ 

CaidaoBM dcxura tigm id da F 
mcd. Wckaadv^ t9tA.aBi, 1177 

SoaM iivortaat BaBdaikM c 
rectal ootlcC. G. STBaST PiadoL ft 
1916. I 149^ (Abdraclod l aM n M l , Aha. Sam., 1916. 



Um 



BIBUOGRAPHY OF CURRENT LITERATURE 



PNliflUiMry raport; aiMHomkal and bactariologfeil 
fadiiiti of tbt Moracul f«|loa. I. R. Psmmmotow. 
Pioctd. k CmtnmunL, 1016, i. isi. 

ForaigB boiljr is Um ractun. J. F. Prakt. Laacct. 
L4mmL. 1016, cxd. ii^. 

Fbtab of the rectum. C. J. Divkk. OUcafo M. 
Racoider. 1016, uxviU. 511. 

Caaccr o< the rectum. W. F. CAnrsKix. Med. Tiin«. 



J. F. SATHia. 



tOt6. xUr. 3t3. 

Hex t«l (iticntiaai oadcr locd i 
N. V. M. 1.. ioi6. dv. 644- 

The radirml aprratioa for caiwcr a( the rectum and 
iimiMitiniiiil \v. J. Mavo. .\nn. Surg.. Phila., 1016, 
Isiv, 304. 

A ikmflm technique (or reMction of tho prolapied 
ractom. G. W. Bkock. Surg.. Gynec k ObtL, toi6. 
BdU. ai5 (Ml 

OlMeivatiom oa fiiMure in ano. R.H.Basxss. Proctol. 
k Gastroenterol.. 1016. s, 173. (Abstracted Intemat. 
Aba. Surg.. 1016, xxiii. 466.) 

The MDCfiority o( the riicht Mde anus in the handling 
ui partial and complete ol»truction o( the lower colon 
ana fi|"»«M in cases unsuited (or radical operation. 

I. Y. BloirN. J. .\m. M. \m.. 1916, Ixvii, 4^6. 

12*1 

Prolapras aai in adults. T. C. Hiix. Proctol. k (ias- 
troentenal., 1916, x, ijj. (.\b»tracted Intemat. \l». 
Sum., i9it>, xxiii. 466.) 

Treatment (or pruritus ani. H. B. Sto.ve. Bull. Johns 
Hopklaa Hon., 1916, xxvii. 242. (27] 

btioloijr 01 vaccine treatment ol pruritus ani. L. J. 
HntODCAX. Proctol. k Gastroenterol., 1916, x, 193. 

The treatment of hemorrhoids by a new method. E. H. 
Tbxmkix. Proctol. k Gastroenterol., 1916, x. 185. (Ab- 
stracted Intemat. .\bs. Surg-. ioi(>. xxiii, 466.) ' 

Liver, Pancreas, and .Spleen 

Radiotogic examination of the liver and bile-ducts. 

II. Pavm. Gaxs. d. osp. e d. din., Milano, 1916, xxxvii, 
1187. 

Two more cases of h>'datid c>-sts of the liver. H. F. 
DstCApo. Cron. mM.. Lima. igir>, xxxiii. 341. 

Echiaococcus cyst at the left Inlic M the liver dischaigiag 
into the left hepatic duct. K. S. Fuwlkr. Long Isund 
M.J., 1916.X.317. 127) 

Pyodeviation of the complement and abscess of the 
li%'er. TaiBOtCDKAtr and Fichkt. Bull. Acad, de mfd.. 
Par.. 1916, Land, 256. 

AflMsbic abaccM of the liver. .\. C. Wood. Ann. Surg., 
Phfla., 1016. hdv. 335. 

An unnaaal computation of hepatic absccm. I. R. 
RitQCEi. Gac. mra. de Caracas, 1016, xxiii. izi. (38) 

Abacam of the liver treated (rom the naginning by 
eaertae. complicated b>' pUebitis and cored without 
lalcnreatim. Liax and Lvok-Cakn. Preme oaid., 1916, 

PtodhmculatedtttaMroftheUvcr. OnnjtmnL Dealadie 
med. Wchttschr.. 1916. xlii. 1086. 

Abdominal gunshot injuries, especially guaahot iajorki 
of the liver. E. Lick. .Arch. (. kiln. CUr.. 1916. cvii, 
SOQ. (38) 

Two operated cases of hemolytic icteraa. X. Hmiv- 
frnnru. Tr. XI North. Swg. Ctmg., GocUbofg. 1916, 
July. 

Relief of chrook otalnKlivc jaoadloe by paiBathre 
operation. J. F. EamiAjni and C G. Hm>. Am. J. 
II. Sc. I9t6. xlii. 174- £3^ 

Dfaeodated iaundice. C. F. Hoovut aad M. A. BuiSnc- 
I. Area. Int. Med., 1916, svBL S89. 



Rupture of the liver. PgtxoT. Frame mid.. iot6. 

Notes oa the radiograaliy of the gaO-bladder. N. Mao- 
Lboo. Arch. RadkLft Dectrotherap.. i9t6, xxi, 117. 

PrevcatloB of «dl-«toaeB. T. A. WATfoa. Brit. M. J.. 
1916, II. 45*- 

Gall-stone disease ia the light of ita oaset. SramosL. 
Aich. (. klia. Chir.. 1916. cviC 379. 

Sobdlaphnupaatlc coBectioaa of pas aad gall doe to 
gilrtonm. RiKiNtL. Detttache med. Wchoschr., 1916, 
xlii, losS. 

Cholecystitis with aad without gaO-stoaes aad a 
classification of symptoms. G. A. HamxM. Tr. South. 
Surg, k Gynec Ass., White Sulphur Springs, 1916, Dec 

Indications (or cholecystectomy. D. Gctmuc J. AaL 
M. Am.. 1916, Izvii. 60. (Ml 

Suigcrv of the gaU-faladder aad biliary pasaagm. iLA. 
SsAW. Intemat. J. Surg., 1016, xzix, 390. 

Congenital occlusion of the bile-ducta. J. Foots aad 
R. Hamilton. .\m. J. Obst., N. Y., 1916, Ixxiv. cti. 

Cicatricial stenosb of the bOe^ucts. HcmcKL. Dcutache 
med. Wchnschr.. 1916, xlii, loSs- 

Pathological anatomy as basts of indicatioas ia Uiaiy 
calculus. E. KiBAS y Ribas. Re\-. de dea. mU. da 
Bared., 1016, xlii, 396. 

Biliary- calctUus. F. MASTKoaniomc. Semaoa mtd. 
1916, xxiii, 195. 

Choldithiasa. J. R. Taylob. Am. J. Obst.. N. Y.. 
1916, Uxiv, 51$. 

Choldithiaais. R. A. Batc Am. J. Surg.. 1916, xxz. 
J9J. 

The dietetic maaagemeat of h>'percholotenemia in 
cases of cholelithiasis. M. A. RoTit^~HiU). .\m. J. M. 
Sc, 1916. dii, 394. 

Acute suppurative pancreatitis; gangrene of the major 
portion of the |>ancreas; recovery; determination of paa- 
creatic function three yean subsequently. K. T. Mitijnt. 
.Nnn. Surg., Phila., 1916, Ixiv, xap. 

The spleen in its rdatioosnip to pemidous angmia, 
nlenlc anemia, and hjrmol>tic jaundice. D. C. BAurotnt. 
6mad. J. M. k S.. iqi6. xl. 47. 1^1 

A complication arising in the treatment of a solcnic 
enlargement with thorium-X. J. Bagce. Tr. XI North. 
Surg. Cong.. Goeteborg, 1916. July. (33) 

Splenectomy. J. Scaoc. Ugesk. f. Laeger, 1916. Ixxviii. 
1609. 

Splenectomy (or hemolytic jaundice. C. H. Pcck. 
J. .Abl M. Aas., 1916. Uvfl. 788. 

Indkatiops (or spleoectomy ia certain chronk Uood 
disorders; the technique of the operation. D. C. Baupocb. 
J. Am. M. Ass., 1916. Ixvii. 790. 

Splenectomy in splenic aoarmia, hcmolytk icterus, aad 
Hanot's drrhosis. J. L. Millci. J. Am. M. .Ass.. 1916, 

I«vii,7a7. , ^ 

Splenectomy in pemidous anemia; ttaom oa boa»- 

marrow stimulatioo R. I. Ln. G. R. MmoT aad 

B. ViMCSirr. J. Am. M. Asa.. 1916, Izvii. 719. 
Pemidoos aacmla treated \iy spleaectomy aad qrala- 

matk, oftea-rcpeated tiaarfnska of blood; traasfnrioa ia 

beaaol pdsonlng. R. D. McCmaa. J. Am. U. Am.. 

1916, Ixvii. 703. 
Late results of splenectomy ia pcrakbas aanala. E. 

B. KancaaAAa. J. Am. If. Asa.. 1916. fatvB, 7>J* 



Abdoaiaal paia. J. R. Ectst. Colo. Med.. 1916. ifil. 

llofaOe buOeu in the abdominal cavity. Baaanr. 
1. 1916. p. JM. OT 




INTERNA I lONAl. Ai D \i T OF 2iLKU£KY 
4.«^ t 



J MlMHk l^l^ OWi, 1094* .... _ 

Ha f«lt «l iliiwipnili te utkWi JrfnnmM, D. 
ivn. Amu J. Oilk 9m^ miA» dv, sif (XK 

BvaMiattaa AtmA tkt WfWifB. A. LnRm- 




GyMC. * ObiL, t9i6, nil, an 



SURGERY OF THE EXTREMITIES 




Yooml Amu tati^ Mh^ i«i6, farfv. j6t. 

oa tlit 

9m MMcki«l «lUi MMrftaid bmrftb; alM on Um 
«f iImIw iliiilifi ki other pait» ol Um body. 
M. Bnsv. Aau J. Oitk S«m.. 1916. dv. 4S«. 

Ukytmk. E. S. BuumL 
Aa. J.'RoMMaMHL. 191*. HI,' 4Jt. 

Ahwwi ia tW JMwr A w toWwtyMi Willi iMiMiw coB 
•■d baditaB pontyplMMaL J. C. Binus. BdWk. M. J., 
l9iA.avii.i7S. 

LocaUMd oM«»MMl>«ii* W.CCamthu. J. Am. 
M. Am.. 191ft. Ii«8, S7> W 

1 \\ Fbakb. Abb. Swf., 
1016. Idv. jf I. 
TW cvolaliaa of ortoodmidrili* dcioniMas com 
A.H. Pkinno. J. A«. If. Am.. 1916. Ix^ 

Ho di^Borii of hoM ud Mat twhtrnkak, G. 

Udi.-SodML HndL. 1916. sHi. 746. 

to tlw poUMBONrii <d Oupwi VfJ ftfl n f 

T. Omia. l^ldfaL. Rooo, 1916. uUi. >is- 

(Ml 
• of foBiir. J. A. HAKnrsix. Aao. Surf.. 
•916. Idv. ^7. 

<d taw pwwtmii traaadi ol tlw Iumc 
B. Loipi oad MnwiiiM'fjtftMg BdL ol arfaL Soc 
do cMr., Por^ 191^ rfH. 9171. 
A caw <rf b o i od Woi y isradoctylia. W. E. L. CuutK. 



Laacoi. Load., 1916. did. 4m« 




NodwL TIJdKiv. V. GmmmIl, 1916, fi, 1171. 

Wo«ad» of IW Ibi|» oftindotioao, pailkalody of ilw 
kaoo aad hipi Pbat. BdL ot arfa. Soc do ddr. dt 



r.. t9t«. dii. tTH. 

PMoftlcalor alocaw 
of tho kaoo. Qunrr. 
Plw..i9t«.dil.i7i^ 



ML 01 
ofjoiateia 




m 

orthrilk 
'80c do ddr. do 

m 



^ iJfciJ£'if*t2? 



I9i^l^,iyt. 
B. C flbona. 



'JOIBt. J. K. 

Cvjr'o 



A OMO of offthraoM «f Um vaotw iaioraiM miiiii P. 
Baool Tr. XI North. Sofg. Goaf., Gooi«boit, 1916, 

OlMbUag awculof oaoawly of hoad. D. B. Prama. 



of iho 



Aaa. Salt., PWU.. 1916. blv. itoi. 
CoatiactaiM of tho hoad of tor 



Vmh. W. M. MacOomalo. 



I3i 



Practuroo and Diolocaiiooo 

CO. Baoxsv. .S. 



Obocrvatkio 00 IrocturM. C O. Baoxsv. .S. i . .^i J. 
Mod.. 1916. svi. 4M. 

Pnictvio of iho odoatoid pcoooM of Iho oili. P. u 
BuroK. AM.J.0rth.taf^i9i«.is,U9._ m 

Boichsioviak t oMoanoa wnt for 91181 fiifia f t of tho 
haaMiw. H. H. If. Lnx. Aaa. Soif:. PhBo.. 1916. 
hdv.jsj. 

PtactuTM of the lower end of tho hoaMrm. W. E. 
Labo. Botloa M. k s. }., 1916. duv. tto. (]S| 

A dawlo OM th o J of pattiag op fiactmo ia tho laoioa 
of Iho dboa^joiat ia tho frf|riMMd podtioa. L. C 
RnrcTT. Brit M. J.. 1016. H. tjft. (M| 

Sabhnatiaa of tho hiod of the radfaM; loport of • com 
oad ■Botomirol n i n o riM O B lo. C. A. Sroas. J. Ifo^ Si. 
M. Am.. 1916. xiii. 470W 

FnKture of the tropeooid. A. If ooancT. PtOMO odd., 
1916. p. 45>. 

Fractttic oad dyocotioa of Ihc pwrinMl tad of tho 
fiist awtacMpol boao oad fiactara of tho tiapodoak 
C. W. faaam. Mod. Roc, 1916, ac, 119. 

Pkadano aboBl tho wrial ia ddUhoodoad adoianact. 
A. JiX BumiUL Aaa. 8oap.,Ph Ba., 1916, hrihr,^i t. 

coaMcvilvo to dlMiticalitioa of 



Tho iwalMwl of 
HAOumow 



miii.. 1016. p^ 439. 

coafBiiitAl liuAiioa of iSt Up-Mat. 

SvoM. LaoL-Sodht, HoadL. 1916, sdH, 



Tho twolMOBl of Up fractaia. 
L ft S. J., 1916, dbacv, 43$. 
PVaclorM of Iho Iomw ortfi 



F. J. Comw. 
B. H, B 



M. 



Mod. J. Aortnl.. 1016. li, 107. 
Tho uoatoMat of giiwhiii fiaelarM of tho 



m 



with 



oaaapmBHy 



H. W 
1165. 



of Iho 



ia war. Bvmabd. Lyoa cfir., laidk liB. 710^ 

Ptadam of tho lor. wJiiiwi m om haadiod 00a- 
Mcaliva cmo». F. E. Cboooa. J.4<iaoii, 1916, nvi, 

^hoBnod aiica oad whid chair la tho uootaoat of 



Gac, I9I4.IB. as$. 

■adorio dao la a loa^yomy ooliapdocloMjr. R. 

B. BoB. ol ada. Soc do ddr.. ntf^Tioti. dB. 



»•?$• 



d Mica oad whid chair la tho 
lOfthoaodiofthafMMr. G. A. 
loalf.*8.J..i9if^dirr.44». (») 

llidkipndiof fcacbaoof thoaockof tholaaar. J. 
ajiMiuia. Loi«ldoadM.J..i9tft.i,jt4. 
_<MaihoC tiaUM M of Iho loaf boaot. BsaLASBST. 
Vradi, 1916. IV, loft. 



BIBUOGRAPHY OF CURRENT LITERATURE 



91 



Ijktiy UcaUnent <W (nutuns <d the tWgh is vtr. 
J. Ii'«<;vrm. Lyua ctur . igi6, xUi. 791. 

Th« umUMBt €i diubyiuy liacUVM ol tW fawv la 
M MBbriMM at tka mat L. S u K u tt . Lyoa cMr., 
i9i«. liH, nt. 

Cvtaia ndi WCotIm IIm Opw mri v treatment o( 
fnctwaoftbajMtdk. CL. Samoa ud R. H. Miixn. 
BoMoa M. ft S. J.. 1916, dsxr. 441. 

Report U two CM«i ol compmiiid fracture of the tibia 
aad fibola. with dUocatkwol tba aaklc. F. A. Wk»». 
lalarBai. J. Surr, 1916, nis, sSS. 

Oa calci fracture. F. J. CorroH. Aaa. S«|., Phia., 
1916. bdv. 4te. 

Saigkal trcataamt of cnnip o u i id ffactoraa. E. D. 
S'lVBU. latenau. J. S«|^ i9i«. nls. 177. 

SoBM SipacU of the tre at aaea t of co a w p min d fracture* 
aadar dvfl aad mflitaiv oooditiooe. D. Cnotvn. 
Baeloa M. k S. J.. 1916. clixv, 4^2. 

A plea for miMfrretiew ia the treataieat of doeed 
fracture* from a roeatfeaokckal e >a a i lp e i at . S. B. 
Qmaa. Abil J. Roe a ttead .. 1916. iO, 490. [34) 

TIm tayortaam of aailjr redncttoa of fractures with 

i<ii>lei.iei L W. Dauaol Boatoa M. k S. J.. 1916. 

cfaBnr.437. 

Treatmcat of diap^naiy goaehot fracture wounds at 
the froat. G. Cottx. Lyoa chir.. 1916. nil, 698. 

Tbe trcatnwat of uaaaited fractures by the use of bone- 
sraft. F. DxAX. Cola lied.. 1916. zui, a68. 

Tbe eliding graft aad tbe kangeiroo suture in fresh 
fractures; Albee tecbaiqae. W. LAraaor. Ann. Surg.. 
Phia.. 1916. Ishr. 68. (34) 

The citcaeioa treataaeat of guaebot fracture*. E. W. 
If. Gaovcs. Brit. M. J., 1916. ii, 3J0. 

Sttfganr of the Bonca. Jointa. etc 

Partial artbrectoiny of the •houMer. C. P. db Bellako. 
Gac mid. de Caracas. 1916, zxiii. tsj. 

Soaie priactpIeK ia tlie prostlietics of the lower limb 
A. BaocA. Pna* aiM., 1916. p. 389. 

loag legs aad Itagthming short legs. R. T. 
a. J. Ortk San., 1916. zir. 59S. (t4| 

tdoa with erteasina of hip- joint dating tran*- 
portatioa. A. BsaDtAzrr. Russk. Vrach. 1916. zv. 
807. 

OfthooMMrpUc rwection of the knee articulatioa. F. 
Dtnuurrs. CBa. chir., 1916, xziv. 811. 

The treatail of knee iajuries at the front. L. Sax- 
caar. Bal. el arfas. See de cUr. de Par., 1916. dii. 
1964. 

TreataMat of peaftrathig gaaahoC i^juric* of the knee- 
joint at the front U. CAimA. PoBdia.. Rooaa, 1916. 
xxiii, MX. prmt., 1195. 

Early trattinent of knee injuries excepting those with 
oeseo u * destxuctioa. J. Boaq wa n a . Lyoa diir., 1916, 
xiii,6jj. 

Tbe treataeat of spreined ankle. S. B. R otaiu w u o. 
N Y. M ;.. 19t6.civ.su 

launobibty after joint injury. J. Coua, Laaoet. 
Load., 1916. oKi, sjS. ftT) 

Operative treataaeat for threatcaed g*ngiwii of the 
J. S. Hoasuv. J. Abb. M. As*.. 1916. Izvil. aoi. 

C Boacaoaavunc. Tr. XI North. 
Sajt Coag^ Goetaboig. 1916. July. (371 

CMinrla*ii aad ortaolaaqr. W. BLAMCSAtD. J. Aak 
U. Amh Wt, bnrl, oat. (37] 

RaBoval of aohpatalaal boae frapseaU fai the priaiuy 
treataaeat of aiWiej woaad*. R. LmoB. PreMe 
mfd., 1016. p. 40^. 



TAtuia. AaL 



AIXAI7D. Pari* 



Fat lanhnH i ia hi boaa sumarv; iarideace aad preveatioa. 
E.W.RvnMM. J. Aak mTAm., 1916. Ixvii. 657. (37) 

Boa»fralt* aad Atba*"* aMihod hi iMa£t&Dife aad 
loeea* «l boa*. F. Okun. Um. ffa. da cHa. cc da 
tbtrap.. 1916. BEK. 661. 

A aow B Mt h od of boaegiafth^ ia 
Albee"* aaolhod. J. Calvb aad M. 
aaM., i9t6. vi, 364. 

The appB cati oa of the b oae gra ft in the treataMut of 
partial or ooa^plau avaUoa of the adfllaacaat tMal tabar. 
de (ooaMaoaljr nien ad to a* OiMoed-SdUaltcr'* iMimh). 
R. E. SoOLB. SaiK.. Gyaec k Ohal 

RwnaalHaHun of two-thirds of thi 
perioadcregaaanalioa. G. Novi-JoansAm. Lyaai 
1916. aonr. JST. 

Hitolngic tiaariaatioB of a cartHagiaou* csafl 

oath*. L. iKaaar, L'Hccaxtrx. and RoonA> 
BuB. at aitei. Soc de diir. de Par.. 1916. 



iSi 



with arthroplasty in serous ankyiosis. T 
Rovabio. Tr. XI North. Surg. Coi«.. Goeteboig. 1916. 

July- m\ 

Transpianution of bone in fractures. M. S. Hcxoca- 
SON. J.-Laocet. iQt6, xxxvi, 540. (38) 

General principles to be observed in bone4raacplanla- 
tion*. C. A. McWauAM*. Med. Rec. 1916. zr. 408. 

Trannlantation of the articular ead of bone iwHtfdfi^ 
the epiphyieal line. S. 1^ Haas. Saig., Gynec It Obet., 
1916. zzifi, 301. (38) 

New e ip a rint ea t* regardiag homoplaetic traaaplanu- 
tion capadtjr of epiphyseal aad Mat cartlage. F. H. 
VON TArmxnt. Arch. f. kfin. OUr., 1016. cvii. 479. 

Wewht-bearing amputation stump*. V. ScBALDmoaK. 
Tr. XINorth. Surg. Coog.. Goetcbotg. 1916. July. (39| 

Late eoooomic amputatioo in a case of fn»en foot. C. 
WAUHza. Bull, et mtm. Soc de diir.. Par.. 1916, 
zlii. 2184. 

Septic infections in wounded limbs; a new bath b hori- 
sontal position to combat them. I. GtnsKPPC. Gaza, 
d. osp. e d. din.. Milano, 1916, zzzvii, 1173. 

Ortbopedica in General 

K. R. CAauNC. Prac- 



R. B. Osgood. J. 



P. 



Recent work in orthopedics, 
titioaer. Load.. 1916. zcvii. 333 

Orthopedic surgery in wartime. 
Am. If. As*., 1916, Izvii, 418. 

Eleventh report of progress in orthopedic 
R. B. Osgood. R. Sociraa. H. BocaoLc, aad 
Boston M. k S. J., 1916, dzzv. 343. 

The functional re-education of the wuaadi 
Rzcmaa. Rev. de diir.. 1916. 1, 668. 

The problem of the chronic cripple. R. A. Htaaa. 
J. Am. M. Am., 1916, Izvii. 985. 

The »*« ' ««f * ' di ai tii>n of oooditioas affftJM poetur e, 
H. L. TAYtoa. Ant. J. Orth. Surg.. 1916, ziv. 569. IM 

A prosthetic appliance to replace a necrosed •hoansr- 
jofet. E. A. Boovc. Am. J. Surg.. 1916. zzz. s66. 

of defotadtie* in tlie beaOM 
J. Am. M. Asa.. 1916. IzviL 

Two cases of coza valga. G. FkSDSo. Tr. XI North. 

Coag.. Goalaborg. 1916. July. HH 

emdaly in coza vara. Voa Bumum- 

. Xt North. Surg. Coag.. Goe U bo w, 1916* 

J<dy. m 

Aert aa ia^ of the healthy faaair iacsttai a cases of thigh 

todans with astaasiva shsrtsaiag. Ducvimo aad 

UfBAV. Lyoa cUr., 1916. sH. 614. 



Aplsafor the 
of baras. C. A. 



0» 



nCTKRNATIOVAL AitSTkACT nv SUROERV 



TIm 

AMvriof 
K.Y. M. J : i«i«.civ. _ 

itewaiM M ibr irvvimrai of aaialor 

C. WaLUO. Arrli tVdUl . t9l6. VoM. 



Mm nvMowat oi imMa laat^ 




lu umUMSi to Um s1m». |ifcjii<BlM|td md ifciwamli , D. D. Aaan. 



Am. M. AMk.. 1916. 



N. Y. M. J,. i«ii, dv, «4t' 

A piM id itmimtmt to lalmfc iMfaljnfe. R. 
I^KTT. J. A«. M. Am.. i«i6. Iivtt. Aji. |ll| 

Tkmumm to Um mcami Hag* of WMMit imralMliL 
W. H. aiUMB. M«d. WofM. i«i6. gohf. M«. 

A piM of itMUMM of tofMiilt punlyiik n&. H. SMmi. 
M. J.. IQ16. tts. SJJ- 



smCERY OF THE SPINAL COLUMN AND CORD 



TWcMa»<> a«iit<at|«aMI»)rpi«MwtpMalyyi 

«l Um tow Kimii> J Am. M. Am.. 1916, 

A taaor mWm froa Um mccjimI ghad. J. C. 
BoiM. Bdtobb, M. J- 1916. ivB, ite. 

TW IIWIMMK «f FMl't (ttMBM bv HMi' MtUMd. 

U.JSmuMft md G. DmKU.T. J. d« cUr.« iqi6. litt, mi • 



W. I * ..n M Jk S J. 1916. ilHv. Ml iii; 

A^ iilih lumlMr in rciatkia lo lMbk«<lic 

j. (* « «^ i.^ Ml mrotmvttu. I. Ukk. S<. M. hoc, 1016, 
IV. 4»n. Itt) 

Amir wpik •nhritfe al the wfmJtoc Jotot. J. K. 
Y»t-»<;. trol. k Cuua. Rrv., iQt6. n« Mfc 

KadoUiclkMm of the lotoal ami C. R. PftAiua. 
Amu S«fi., PhOa.. i«i6. Udv. jlj. 



SURGERY OF THE NERVOUS SYSTEM 



nr aad Ikt UMonr of Um 
J. dt Mid. do ~ ' 



of^ 
1916, luivU. 



b)r wor pw|o rt BM; 14 op- 
A. Bambt. Rev. dc diir.. 



A. 

Ik'oMHb of iW ltod> Mvo 
etaivd CMM «iUi cadraMdl*. 
1916. 1. 754. 

C.B.QUI0. Am. J. M. fe , »yi6. d B, jfl*. 

A. M. Gnwrax udETsT GoBvioLRMk! 
Vnd^ 1916. sv. 7jo^ 

ffoo tiBMfitoato- 



Uoa of jMriphonl mtvm. R. I mimmumm. Tr. XI 
Nortk. Smg. Om«.. Gootobom. 1916. loljr. 1421 

OpcnUvc trMlMcot of ROMtoM to|itriM of pwrifkmm 
aervM. A. D. Lavuivsky. Rwiik. Viadi. 1916. nr, 79). 

Tuowr of Um poMcrior tibtol norvc C. Waltwou 
BuO. ct ataL Soc. de cUr. de Pw.. 1916, lU. jiSj. 

ladkaUowiorUMMitMtogof MTTM. A.G.NAinuim. 
RttMk. Vradi, 1016, XV, tjS. 

Same caaa of ao mc fco BC mlto. E. SAaiT«lfABllli. 
Bull, rt mtei. Soc de ckir. do Kr.. 1916. sitt. i66t. |«l| 

The tnuHfitoauUoo of mwek. R. I^vcei 
Lyoa chir.. 1916. itti, SsS. 



MISCELLANEOUS 



Ukaff*. 



•ic. 



TW 



of the pkyiktoa to Um cmMioI of 
^J. Jtmm%. S. Y. SC J. Med.. 1916. svi. 46*. 



Um caacer jifiiMw j. G. Ciaul J. M. 
Soc K. J.. ioi«. tiU. 461. |M| 

TW totowM c4 ibc I MM M rf t/ to cmmoc L. 1. Dtmux. 
|. Am. M. Am. wt6. ttvfi, 169. 

' cer. C R. BOHL J. Matoe M. Am.. 
t91A.vH.41. 

TW dto g Ma fc of caaoar. E. T. SOHM. Toria, Bmmo 
AtoM. MIS. 
TW dtoporii af ral aaa nw caacar. B. H. Baiw. 
M. J^ 1016. to, 9901 

raMtaMiw W. J. HsDiAiM. J. Cfeacar 
•9*^i.MS> (411 

iMoaidL H. W. Nowiu. J. Aak lart. 

toi6. il, ttrj. 

TW coaiiol €i caacer. F. W. BAMCBorr. Cotoc Mod.. 
t9ift. itt. i;i. 
TW inaiaMal of 

•916. SSBVfi. too. 



TW diagaortk vafae of 
A. H. Rofvo. PiaaM aiid., 

Oaa toadiad Udity a laa( 
lC-ny%. B. H. GaoaaK. 



^Qtokd, 



4^r •uraui 



litolakfk 
tiaalad E> 
NooBB. J. da writ 

A caaa of aragiuM 
Gano. bU/M.J.. 

TWnuiia 
Baato. B. Ki 

DaM tola aacrarfi daa la 
toriaw. G.A 

lalaaMMUoa vRliniBfd to ha 



laadka to caaow. 
,1016,0,114. 
af A caacar c«^W 

t«ii 



Mid radinlogfa birtorjr of a aiya»- 
•adT. 



C. RaoATD 



. J.. 1016. ivU, it?. 
aiMMU of IW an« 



m 

D. M. 



of 



1916, cad, 4J4. 

lih 



10 



N.V.M.j.. 1016. civ, «40. 

TW dtoaaoMi aad liaataMa 
■AOKM. lalenL M. j., 1916. 

TW dlMBodi of iW tolaraal 



of 
1916. niil, y9t. 



R.R«ax. Mad. 



UAaaowia. Wa«.M. 



If. R 



••I^BBVi,t}. 

rdymaayi. 6. Sooia aai A. aa Cao- 
faoL !toav. Icml de to SifaH.. toi6. nvlil. t. 



BIBLIOGRAPHY OF CURRENT LITERATURE 



93 



Uai^MHMa't diMtM. C. VtoNOLo-LirTAyi. RifonMHMiL. 
1916. uiU, 1061. 

Auiulyili aad iatcnial menftiom. G. Isas aad A. 
FAt.ii uu. SprHmcaUlc. 1916, hs, 965. 

Tltc rrUtton brtwcn tlw liypophyiiB and tlw tkep and 
kthany ol hatonatiag BMBiBwIi A. Salmon. Speri- 
■Mnulc. 1016, In. 345. 

AcattUhypafMkukm. L.N.BonoM. N.Y.M.J.. 
1916. civ, 490. 

AotMBaaJy and RcckliaglMiMMi't diMMe. A. uk 
Ca0TW>. Nouv. koa. de b SalpAt.. 1916. uviii. 34. 

Diaoffdcn ol the i hy— i to the adult. (;. H. Huxic. 
Med. Hsrald. 1916. nv. J41. 

The iadkatiom for Mirgery. E. J. III. J. If. See. 
X T 1016 dU. 468. 

S«ra, VacdoM, and Faracnts 

Tbe Mndfakgnoiii o( goaorrltts. M. KiarottYNEt. 
CaUf. St. J. Med.. 1916. dv. 451 \M\ 

Spcdfic Mnim trcauncnt of woundt. LKLAmaat aad 
\allU. Bull, rt mtm. Soc. de chir. dc Par., 1916. zlii. 

1804. (^1 

Tm tpeciBcity of tbe WaMemuAo rcaclioo. K. Biu- 

MAM. Surg., (ivoec It Ofast.. 1916, xxiii. 384. 
Reactiottt a(tcr iajectiont of antitetaaic Mnim. Baxy. 

BuU. Acad, dc mM., Par., 1916. Uxvi, ai6. 

Blood 

Newer •spfcts of blood examination. R. WcBsrsa. 
Cbicaco M- Kecofdcr, 1916, xxxviii, 521. 

Induced IcuoKyUMb a* an aid to »urger>-. W. G. 
Fkauck. Med. Times. 1016. xliv, 349. (45) 

PiMrmlnition of bacteria in the blood. A. J. HiNUO- 
UASH. Med. Re%'. Re\-s., 1916, uii, 664. 

Blood fat before and alter splenectomy. H. Dt*MN' 
and R. M. Pebce. .\rch. Int. Med., 1916, xviii, 426. 

Some jMfactkal note* on blcxtd-preuurr. (i. V. DcAt- 
•(•■N. Med. Rec, 1916. xc. 4»7- (44| 

Studies in blood-prcHure, with especial reference to 
diastolic and pulsr prcvurc readings. W. W. Caobcky. 
Arch. Int. Med.. i<;i6, xviii, 317. (44] 

The intravenous injection of oxygen ga» aa a tbeia- 
l>ctif I measure. F. W. TiNsicurrE and G. F. Stcbboco. 
I.a[;> ct. Lood.. 1916. cxci. 3J1. [€7] 

Tbe coagulation of tbe blood in operative intervcntMO. 
G. BotoomsL Clin, chir., 1916. uiv. 713- 

Mesenteric tbromlMMa and cmboli»m; report of 35 cwn. 
J. H. Blac KBiR.x. Sooth. M. J., tatty, ix, Hto. 

Tbe direct traMfurioo of bloud. .\. PamBosB aad 
E. S. RvKBfON. Brit. M. I.. 1910. ii. 384. 

A new method of blood-traaifusion. G. Blecmmaxm. 
BuU. .\cmL de mM.. Par., 1916. Ixxvi, 143. 

Tbe eaqdoymcnt of blood-transfusioo in war surger>-. 
E. AiCMiBALD. Laaoet, Lond.. 1916, csd. 4'9- 

Arterial contractility and stovaine in connection with 
blood-tramfudon. Basdiui and Clesmoxt. Proac 
mU., 1916. p. 425. (47) 



Blood and Lymph V< 

.\rtcTio\-enoua aaeuriun of tbe Urge neck v—di. Roa- 
auis. l>eutadw awd. Wchaachr.. 1916, xUL 1071. 

Two caica of arterioveaooi aaettrim of the faaMtial; 
qoadniple ligature with cxtifpatkm of the iatenaediatc 
vaacular Mamcnt. J. Botkei BoB. Acad. do. mdd.. 
Par., 1916, uxvi. ajo. 

A caae of femoral arteriovcaout 



le vcaou* pwlMfinw A. O. Fmuca. J. Mo. St. M. 
Am.. 1916. xiii. 468. 

Aftariov«MNM aaaarim of the portal vaia ngioa. S. 
LnoiraKAiA. Rmik, Vndi, 1916, xv. 80$. 

A a e uriMna l Iwwatiwna of calf of tag; inddoo of the mc 
aad ligature of the artcdes. PaocA*. Bull, et m^m. Soc 
de chir.. Par.. 1916, xlii. lacS. 

Multi|4e ancuriams of the pulmoaary artery. G. D. 
WiLJir.\s. llygiea. 1916, IxxviU, 1J07. 

Tbe aneurisms of war. H. von HABcaaa. Aidl. f. 
klin. Chir.. 1016, rvii. 611. 

.\ncurisms due to gtmahot injtidca. Gcbclk. Bdtr. s. 
Uin. Chir. 1916. c, KricgKhir. Heft. 35- 1471 

Operative treatmeat of traumatic aneurisms. V. A. 
Cmaak. Romk. Vrach. 1916. xv, 801. 

Dry wounds of the large vcmda. J. Kioixc. BuU. ct 
ndm. Soc. de chir. Par., 1916. dii, jmq. 

Partial ocdusion of tbe aorta with tbe metallic band; 
obaervatioot on bloodprcasurts and changes in the 
arterial walls. M. R. Reid. J. Kxp. Med., 1916. xxiv. 

187. m 

An experimental study of circumscribed dilatation of an 
artery immcdiatdy distal to a partially orduding band. 
and it» bearing on the dilatation of the nubdavisn artery 
obscned in certain cases of cervical rib. \V. S. HALtTEO. 
J. Exp. Med.. i9i<>. xdv, 371. |44| 

Some cases of improper ligation of the arteries. <«. 
Maskata. Gaxa. d. asp. d. din.. MQaao, 1916, xxxvii. 
1037. 

Suture of the cxtemd carotid artery. G. L. Gestbo. 
Polidin., Roma. igi6. xxiii, sex. prat., 1304. 

Potaona 

Tetanus in a child cured by intravenous intensive 
serum treatment. NoBCCtrKt and Pevbe. Prcssc 
m<d., 1016. p. 433. 

The propnylactic use of antitetanic serum. W. H. 
Li'CKETT and R. S. KsAPr.' N. Y. M. J., 1916. dv, 514. 

Surgical DIagnoaia. Patholog>- and Therapcutlca 

Tbe healing of septic wounds. I>. II. Stcw-ixt. West. 
M. Times, 1916, xxxvi. 8$. 

Pain as an indication for surgical intederencc R. J. 
Bbham. Penn. M. J., 1916. xix. 908. 

A plea for more necropsies. S. M. JdAEWOLE. Penn. 
M. J.. 1916. xix. 000. 

.\ note on tbe scctiond method of leaHiIng and studying 
macroscopic anatomy. J. V. SmAsrrEB. Penn. M. J., 
1916, xiv. 894. 

New indications for magnesium injection. \. Tab. 
Deutsche med. Wchnscbr, 1916, xlii, 1069. 

Intravenous injections of h>-pertooic sdutioos of grape 
sugar in treatment of purulent p rocemea. G. I. Baba< 
Dt'UN. Russk. Vrach, 1916, xv, 833. 

Experimental .Surgery and .Surgical .\naio«ny 

The adread glands. I. G. Coaa. Med. Ptbm k Ore. 
1916, di. 186. 

The spootancous librralion of cpinepbrin from the 
adrenals. G. N. Stkwabt and j. M. Rocorr. J. 
PharawooL k Exp. Therap.. 1916. viti. 479. (fll| 

The ia f h w iare of the adreaab 00 the kidacys. E. K. 
Ma— All ■ JB.. and D. M. Davo. J. PharaMoL ft 
Eip. Therap.. ioit>. Wii. 05. |SI| 

A (tnther study of the gastric ttlceis faloadag ad- 
laaaliriiiiii.i F. C. Ma.\x. j. Exp. Med.. 1916, xxiv, 
JS9. 



94 



INTBRNATIONAL ABSTRACT OF SURGLRY 



TW iMwi Mriad l« Um gmvlk «l tectMM. v. M. 

■MV. J. Itop. >i<4H If t4, aJy, jiy. 

T W liirtirii liiti ol tfc t trtM te fatlMy cMMm and 

mSTiI. r^niMU. Am. |. Mi. CUM^ if lA. ^ 

**hrtlMrhi>iMhwfllilwli— dlurymiiBliilnnl 

■■> MsmpaoB w ■■■■■■ Hom or iBi unnvH 
BiMim ■■— H. D. flAHHB Md J. M. Rooor». I. 

fW tiMM^Iulalioa of Im Onrioid flMid to doift. 
CGuuoiux. AhlJ. M.8ctft$cll,j#l. Ifil 

A tiady «l llH ii^iliiflnl MMy gidwnimu ol 
ikt tlvnU #Md, to ntolln to Unlr todtoa coataat, m 
flvMand ky in«H imrlBiih oa ta^dm, A. 
G«A«Aii. J. Ea^Mad^iftAialv, 145. 

Tkt chMlflcMM of mnbiosoocC W. L. Houiaii. 
J. Mid. RMMck, ifi6. mhr, 577. ini 

l^fltoMMri nHMdMeMantaf Um hypoplqrrii M 
aM Ins* B. A« Hoomav. Pimm mM^ AimbL, 1016, 

^■. lui 

fWplMnMcatogjrof llMVMdihNM. I.A.WAOiNax. 

Aato««I^BliM«fvivtacli«L If.jrwiBTTV. W«t. 
M. ThMi. ifi6, Bonri, 97. 
Ika taapaalara w ctfaiw to ■ipludirii, U. L 
1016. 1. 90t. Ml 

MTvouimtMi; ftdtokal 
Ml tovattoMioa. D. Ou aad R. G 
M. J^ 191^ svii, jt. |Sf| 

ol lh« «•«! ■pomoipliliH to 
raai iIm mpintonr jMMOfM. 
D. M tA P*i ud P. Gakia. PMbotoo J. Sc. iot6, 

si. SI- In 

LatoMof Uw tkw — toctoa to tW dgiiluuiuMi of 
•ipatoMaial ti — o n . F. PimiiAUi. S|wn«wHlo. 
ift*. la, ijT. 

TW pOTpMnl actiaa ol oofam ■M'«*««Hf with i»^«f 
ralOTMo 10 Um biMkfar. dTe. J*cnoM. J. Ub. ft 
Oto. Mod.. 1916. 1, a6j. 117) 

DolOCfhM ol MM! MMMMlS ol blood. T. H. KKU.T. 

J. UbL ft Oto. Modw 1016. 1. 197. 
~ ' 'olllMiJWlMMaUMMfttovitfo. k A 



i^^wm jowdiiar Md ndhM llM 

SoiM UmonimI ommMmmIom ob 

ifidbClnv, jai. 
8mm CMMM of OTor to Um fOMMfi 
IktoleoadMoM. R^Hammmb. Am. 



H. 



nMsmmL. 
t ii udm li J. J. twoSTT^KX M. Am.. im«. 



I9t6. 



loll 
Wbo. Pfeib aidn 1916, vl. 

TW hto hjl M l dioct ol rooMfM myo o« Um 
P. BunMimut. DooiadM nod. Wctow 
ilii.tit4. 

Co«t«dlal oaonaltoi mad vartotJow ol Um bo^jr 
M rtvoiJod by Um Xray. A. HAsnnn. Am. 

.,1016, iii,.4jo. . m 

ol tooponUt MictoooM by fthnrtif loMi^ 

UoB. G. B. Mamkv. Mod. Roc, 1916, sc, «ts. 

Efforts ol nCooUoa ia Um kidoioy ol m«tts nMilniid 

ly. W. P. BiAASca aad F. G. Hamii. 

, i9i6.clU,5j6. |ffl| 



J. 



A-fT**;'' 



bnu U. J.. 



Tao MnponMn nocDOM 
TmI MmiIm ol Um wtiai 



ROMR. 



MHonr. j. &^ Mod.. 1916. sshr, 567. 
NoMi om Um piMocUvo actios ol ktob 
M aad oagnM «poa Um limi caii to 



N.Y..t9iMaiv.4m. 



iu domAIs oppHcaUoa to nt^ 
L. f . UVAKS. An. J. oCu, 



vWl Um CooUdfi Mbo. J . H. 



Nonb an t Mod., 1916. tv. jeo. 
BaQ npn mcshmuob 01 prafocnni 99 n 
^___ iAMAa aad Mwwm. Rov. fla. do cml 

Tha Mdhiaiic Msaaorii ol 
BonM4MAi9> J. do ndhL 



toPMacb 
M.J, ifi«.aiii,feft. 




Mllitaffy SoftOTy 

A proUstork war wooad. L. F. Wist 
1916, U, »8t. 

Shdl toiaUn to Um pfOMat war. P. Baoul Tr. XI 
Noitk 8«i. Ong., Gootobotg. 1916. Jolv. 

Plon of Ml wwjhlai 18s graaM to um doiaal logloA. 
E. QvtMV. BoO. ot aJMa. Soc do cUr. da Par.. 1916. 
sttLajor. 

WdPsdlMaM a* it has utcurr sd to the army ia Flaadork 
A. Srooi aad J. A. Rruc Bril. M. J.. 1916. ii. 413. 

Tbo fMOOUi oooMdkatioas ol war woasida. N. 
Lafbysb. Prano bm, 1916, p. 4J1. 

Gm fUMNao M soaa at tbo casoalty doariag 
C Waliacb. BilL M. J.. 1916. U, 3S1. 

Paitbor ubsMisUoM oa ibc trcataMBt ol gsa _ 
tor tba totravcaoai tojectioa ol bvpochloroiif acldl J. 
nuao aad H. J. BAna. Brit. M. j., 1916. ii, ijr. 

m 

r ^ m ^f^ Ifc Mun OB flMMMBoas Mpcicaada. Baocd- 
llod. Pnn ft Cbc, ifii, ci. t&fT 

A brW saivcy of soBM oapntoaon to tbo oaninr ol tbo 
proMat war. E. A. Abobbaud. Csaad M. Ask J.. 
1916. vi. 775. ^^^ 

A rovMw of BMdictoo aad sanwy, wilb ipocHl niWMoo 
to Um Earapoaa War. A. W. H o bwb o mw . J. Midh. St. 
M. Soc. 1916. sv, 415. 

Moddac aad MUfsry to andna waifua. B. Jabumb. 
N. Y. M. J.. 1916. dv. S49. 

Tbt ottiactioa ol war iwnJsrtBn, 8. MnrAPi Ror. 
do cbbn 1916. 1, 697. 

nMgiiaio's Uoi irawWwator to tbo SMidi torpMfartlas. 
V. M abamjaiio. Gaas. d. ospw d. dto., lOMa, 1916. 

UAVU, ISMa 

Tbt tiMlnwit ol war tojartoa. H. Twmum. Bokr. 
s. kBa. CMr.. 1916. c Krii«Kbir. Brfl, t. 

Tbo opM tiMlBMBi ol woaadi to war. G. Sbbtmcb. 
Bokr. a/Uto. CMr^ i9i«. c. KriMicMr. Hofi, 19. 

■■it of war auaaiM by Ma Carrol nolbad. G. 
aad P. Pbbbm. R«v. do ddr., 1916, 1, 617. 
of waf aossili by cbtortdo of 



I. do tatUL ot d'Mif I . t9«6, Jl, n$. 
m tondhitaB oa Bvtog oBk W. L. 
J. M«. St M. Am. i9i4. sB. 437. 



•aSA^ 



m- 



Inm tbo btolMk tMadpotot. B. Bbb- 
d. oi|>. d. dn., Miaao. 1916, sovil. 



BIBUOGRAPHY OF CURRENT LITERATURE 



95 



Tht OM of petrol (or donrim wooaik. M. H. 
Bril. II. J.. 1916. U. j>7. 

TlM Mil padi twti— It ol iafactad giimhoc woaaife. 
J. £, H. Rowsn mm! R. S. S. SxAnun. Brit. M. I., 
ioi«. U. >Sf. (Ml 



Tb« drmim o( MpUc , 
Laaort. Load., 1916. odTfrS* 
How MpUc war wouadft tlmrid bo trmtod 



W. B. Daw. 



A. E. 



Wbicst. Lancat, Load., 1916, ckL caj. 

A plaa ior igaorlag **laudahle pui^ la the tfcaUaeat cl 
MpUc woowb. U. DoNAUMON. E. AtiODCT, aad A. J. 
Wuon. BfiL If. J.. 1916. U, »86. 

TIm nwchaaJMw of mum draaiatk K. TAVLot. 
Brit. M. J.. 1916, U. jai. 

The primary Imaiadbla suture o( war wouada. H. 
GAtnNsa aad R. Mosttax. Lyoo chir., 1916, zii. 685. 

R«eaiclMi oe the Mcoadaiy suture of war wouoda. B. 
DnriAt. Lyoa chir.. 1916. xiii. 616. 

Rapair of war wouads by bufa aadskia o( aroded tiHtMS. 
H. GUmNn aad it. Moktax. Rev. ffa. da cUa. at da 
thirap., 1916. XXX, 641. 

FIbralyaio io the sui|cry o( war, aad its daagcis: re- 
■Mfks 00 fibroly«in aaaphjriaxis. W. Hnaa. Arch. f. 
klia. Chir., 1916, cviii, 73. 

Tha local ticatncnt of bums on a naval hospital ship. 
R. J. W11XA.V. Brit. M. J.. IQ16. ii. 318. («•) 

Usaturc of the riaht ioternal iliac artery for secoaaary 
iMw au i ih age from the battocfc. K. L. Scott and A. R. 
MtLAanjkX. Lancet, Load.. 1916, cxd. 559. 

Soncry in the ambulancr doae to the hring line. A. 
SCHWAKTZ. Parb totd., 1916, vi. 3^5. 

Critidsra of the advanced sur^inl post. Mastin. 
Preae aiM., 1916, p. 36$. 

Sone imprtiiioni of a civilian at the western front. 
Brit. M. J.. 1016. ii. 432. 

War, prostitution. aJnd venereal disease; the position in 
Gcnaaay. Laacet, Load., 1916. cxci, 567. 

SoBie of Professor Lexer's work at the Red Cross 
Auxiliary Naval Hospital, Veddel- Hamburg, Germany, 
1914-1915. H. G. B»:Yr.a. Bull. Johns Hopkins Hosp., 
1916, XXV, 367. 

Some a i pe rieaffs in the British Hospitab doriac lis 
BMatha* tamoe there in 19 1 5. F. \V. Moeluu. Chlcaco 
M. Raoorder, 1916, xxxviii. 504. 

SwiIgbI aspects of industrial accident insurance. E. 
Rixvoao. I. Am. M. Ai|^. 1916, Ixvii. 1004. 

ladnstrial hemu. W. B. Smith. Calif. St. J. Med.. 
1916, Jdv. 351. 

Rcrtoriag the injured employee to work. F. D. Doxoc- 
■m. Boetoa hi. k S. J., 1916, dxxv, 457. 

Bo^dtals and workmea's insurance. F. J. Corrox. 
11. k S. J.. iot6. dxxv. 461. 



Fliat*aid. J. BcjnirrT. Intcmat. j. Svff.. 1916, 
nis««99. 

Uoapltal. .Madlcologlcal. and Madlcal Education 



May anrHS opiaiooa bat aoc coadurioas. (Taylor 
Coat Co. vs. MiOar |Ky.). i8> S. W. R. 910.) J. Am. M. 



Am.. 1916. Ixvii, 814. 

I — burden 



of proof oa plaiatifl. Med. 



trcatmeat of 
155 Pac R. 



Malpractice 
Rac., 1016, Ixxix, 1091 

No direct daim against aa m lo y ar for MrvioM to em- 
ployer T ^-' M. Asa.. 1916. Ixvii, 901. 

Lia! insanity foOoiwiac iajuipr to s>'philitic 

empiu; .. . .uwley vs. City of LowcU (Mass.). 111 
N. K. K. 780.) J. Am. M. Ass.. 1916. Ixvii, 901. 

Liability for wroog dJagnosis Med. Rec., 1916. 
Ixxxix, 1091. jMJ 

Injury to neck — oomparisoo of X-ray pictures. Med. 
Rec, 1916, Ixxix. 913. (Ml 

Unsuccessful treatment of fracture and failure to dis- 
cover dislocation. (Hotwhtoa vs. Dicksoo ICaBf.]. 155 
Pac R. 128.) y Am. M. Asa.. 1916. Ixvii. 766. 

Use of X-ray in discnnsfa, Med. Rec, 1916, xc, so6. 

Employment by corporatioa. Med. Rec, 1916, Ixxxix, 
1091. (41) 

The pre-existing condition of the injured. G. R. Doas. 
N. Y. M. J., iyi6. dv. 439. 498. 

Damages allowed for malpractice in 
shoulder. (Hoffman vs. Watkins (Wash. 
159.) J. Am. M. Ass., 1916, Ixvii, 834. 

CorrectocM of X-ray photofraphs. Med. Rec, 1916. 
Ixxxix. 1091. 

Compensation for services — failure to take blood-tart. 
Med. Rec. 1916. xc, 419. 

Malpractice under iadustrial instirance law. (Rom et 
al. vs. Erickaoa Construction Co. etal. (Wash.), 155 Pac. 
^- I53-) J' Am. M. .\ss., 1916, Ixvii, 972. 

Chiropractics in practicing medicine in Utah. Med. 
Rec, 1016, xc, (06. 

Psychological facts in medical testimoay. T. D. 
CaoTBXSS. Nashville J. M. & S., 1916, ex. j86. 

Oae huadred yean of surgery. G. K. DiaamoK. J. 
M. Soc N. I., 1916, xiii. 492. 

A disais s i o n of medical educatioa. R. B. DiLixmnrr 
Northwest Med., 1916. xv, 285. 

System of keeping surgical records. C. H. Fiazibi. 
Ann. Surg.. I'hila.. 1916. Ixiv. 347. 

A surgical follow- up system. C. L. Gdsox. Ann. 
Surg.. Phila.. 1916. Ixiv. 349. 

State board examinations and their effect upoa medical 
education. W. H. Wilsox. J. Am. 
IQ16. ix, 217. 



GYNECOLOGY 



Uterua 

Precaaceroos chaagM io the uterus. W. S. Sioxs. 
Sag., Gjraac k Obat. 1916. xziii, 248. (ttl 

Radhna treataMat of oteriae caaoam. J. RAmoaorv 
aad J. L. R a w wot?. Ann. Satf., PhBa., 1916, bdv, : 



The Percy treatmeat of caacer. A. R. Gbamt. N. 
J. HooKxop.. 1916, xzxi. 991. 



r, «^ 
». Am. 



High heat %-erras low heat in the treatmeat of caacer of 
the uterus. H. I. BotiiT. Surg.. Gyaec 4 ObaL, 1916. 
xxUi.s88. tut 

Adeaocaidaoeia of the corpus uteri; aearly ooMpiele 
removal by the curette. R. T. Fbams. Aaa. J. Obal.. 
N. Y.. i9t6,lBdv.j6o. 

The radical abdomtnal operation for caidaoaw of Iht 
cervix uierL C. Bkuookv aad V. Boxxkv. Brit. M. J.. 
1916, ii. 44S- 



INTFR NATIONAL ABSTRACT OF SURGERY 

M 



TIm mumimi afwr«iK>« tor cunawi of Mm 
R. Piim o w, S«nt . <•«•»•(. * Ote^ i«tA, ntt, 9jy. 

iiooi ctMocc in viMtet ibroMk W. J. Ma- 
\m J (Mau . \' Y « 1916, lohr, 44J. 
t*i«fu« tuouiBiac **txvmmlmm duMMrailoa «f • 
ibfuid amI ab imlmmiiral adnHMdMnft. W. P. Poot. 



JLyufttfC el tUK. Ul tttWl— 

a J. RoiBT Tr. SooSTslmi. ft OjrMr. Am.. Whht 
Mnnr SjpriNt*. 1916. IWr. 
rnamk Mcfl. A. N. McUrars. M«d. J. AatUml., 

i«l6. U. t«0. 

Xmy Hi wwt of wUri— IimwijiiIih'' R. T. Pkaitk. 

uartli Bcomm. R«v. aad. 4t !• ftrfat Ron.. 1916. 

snvi,ssi* 
MB«rtkt«l««. D.W.PuDCTm. A«.J.OI»t.. 

%iiiMi ol Ik* to4r a' tJ^ tttanift. C C. Noutt. 
9ml. Gmmt. ft OttfL, 191*. mU, a«t. 

(^•tnMiioa to Um tlodjr of MariM gMMmo &m to 
abonioM. MAOCiAttK. Awk dt gjralc tC d^obrt.. 1916, 
dii.195. (U) 

T«o CM» of vtoriM BvionUoa wiik Imm of foraigo 
bodki laio Uw •bdoalMl cmvitv. V. B. Bbocmax. 
Aml <fe nnrfc ol d'^te^ 1916, dU. jo6. |U| 

RoindHphoMMMs of Iks ateffw, witli opedd refer- 
to tlNlrcMMliM;aM«raMilMd of trmUBcaL J. C. 



HwwL. CriM.SLJ. If«dni9t6.iiv.^9i. 

CoMMiiUl Ottd acaulfvd rrtrnpamMMM of Um ttlcnift; 
llMir diflcfvBtki: 4g nM i f fr . A. Srvtii- 

mmf. .\ai. J.CM lnhr.jS6. 

Utortat ntfodcvmioa. T. J. Pkxaboo. Picbm mtd., 
Ahwh. 1916. tti, 113. 

Tht rMc of llw uttopoMd nlctui !■ tlw CMMStios of 
InritadK awl pdrk qra^rtOM. H. T. HoiaOM. J. 
Am. M. Aak. 1016. Isvtt. 9^ fM| 

of tlw ataraa. E. RBMMMOtiai. HfHk. f. 



. 1916, Inviii, i66j. 




ParttttarlAo Coadltlooa 
avoidad. A.S.Toc«Ln. Wert* 



Aaovadaa 
M. Tfaaak. 19M, mvt. 101. 

Tonfaa Md faKBitcimtiaa of jparovaiiaa qni. E. 
Amutnam. Bvaan Laafu-SaaMu HaadL, 1916, iHi, 647. 

Rawewil of a twaor waliMig •'ikl powdi froai a 
iwaaaa j bI a<|fct y-lh» wmSrQ vTju tod Mio rialfaii . 
G. M. CvwBsic CIdcafa M« Raoatdaf* i9i^t AuviU, 

' tW trmtmml of 
oaqr. II. Ca^fr-r. 
lOtA. lU, aiTt. 
TlictMriiof liwIalalBcaB. A-Paiox AMkdioaM. 



Notoi a» iIm nal, jawtoil. aad lotiwa af 
abaMffca, tad aftdaadnl a«B«y. J. W. BotIb. S«^. 
OjTMc. ft OhaL, 1916. viit joa 

Am ffrttffrtffg cMr itona maHmtm R. 

Amod. A«. J. Obat, "^ > i^.teilif. J97. 

As opanliaB sadBaa uMMaialM iBdiuMd appaBdh* 
pyonipHi« lijFdaBflHplBiitabaoCic vlamkawl ■ b a al d pa|jr^ 
Willi Boto oa Um mm i q i m aanpteyaa. R. WoaaAtt. 
Mad. J. AoBtfaL. 1916. U, 117. 

PreKaaaqr foloarlai «lplafaaalm«ctooix for lal* 
pingitfci and haaalaaa of ovanr. fvadai af adi 
right adaaa aad opaalag daaad 
auBaaaaa aBpaadKiliai 

nTy.. t916.lniv.4i7r 

OtMrvatioaioalfcaoocanaaca of mMbiatka Uaivar* 
dty of Midi^Bta obalalrk aad lyaaeokrikal diak. R. 



a airf opaalm doaad liibas aapaiMiactoaMr fof 

H. N. VtMicaKao. Am. j. (Mac. 

t9t6. btdv. 4I7. 

oalJia< 



PnaaaoM. Satf., Gjraac ft ObaL, 1916, nfll, dtac 
SvpUHlic favor la laktioa to u r awn loi fcal aad d 
rical pcactkc F.J.TAoano. Satf^GytMcftObrt.. 



sdU. «94. 
Tha I— Mied 



matdmMy AaMrkaa 



fcftaky of 
amaaa. 1. S. Stomk. Aai. J. Ofaal., S. Y., 1916, Inhr, 

etioloo- of ktcrflity la woeica. G. B. Miujeb. Am. J. 
Oliat.. N. Y.. 1016. luhr. 45a 
A dataflad atady of the patholockal caoMi of aladtojr 
O. POIAK ~ 



witlitbaaad-fOMdls. J.O. Potjuc. Surg.. Gyaec ft Obd^ 
1916, xdil, «6i. 

The iadkatioaa for aad adviMfaBlty of anificid maMm- 
tioa. R. Y. SmoiVAM. Aak J. Obat.. N. Y.. 1916. faBriv. 

Sia^dc atariUaatioa of arooMa by cautery Mrktoia at 
tbe intrauterine tubd oprwiiy coeiparBd wHb olbar 
aaclbod*. R. L. DimxaoK. Sarg., Gyaec. ft Obrt^ 
1916. zxiii. 9o\. fill 

MaUgnaat cborio-cpitbdioaaa. O. Pwitb im. Ffaaba 
laet. weBik. baadL, 1916, MU, 1169. 

Hyparovaria la Iba ctJopathogMMda of otariaa anroaM. 
T.PiocAiDO. Piaan adi£. Aigaal, 1916. W, 87. fW 

Tba aidocdaa glaadi bi tkab lalatioa to Ibc (cmdc 
gcaanttbra otgaaa. W. Ttem. Abi. J. CNm.. N. Y., 
1916. Isdv. 474. 

Raga^gbaat a w ia a U aalioa throogh the tanopiaa tabaa. 



Tbe 



CG. Qau>.jB. AaLj.Obrt..N.Y.. 1016. Inhr. 414. 
Diaordand maaitfaatioa aa a tympmm of diaaaM 
H. L. D. KianiAM Tobm St. J. Mad.. 1916. di, tiS. 

of wraaaaorrb<aaa wttb a 
ricawKa. Ma 



0, Sltt,(W4. 



Rova., 1916, 
Tba 

VAK. 



|idatyl u a | l ladin d MlpiagoC 



a. Sbc dc chir. 



Taaum. 



M. Picaxca. Mad. Rav. 

d meiHtniatlea. E.N6> 
\MU BaL Jobaa BapUaa Hoap.. 1016. sad. rro. 
Cwild laBaaa aad tbdr idia to tba pradactioa d 
atolaaM arUag fai tba pdvb. R. R. SHna. N. Y. St. 
Par.. /. Mad., 1916. id, 4*9- 

Pddc aMdMaotbaninr. F. A. lUaFn. Soatbwart 
J. M. ft S.. 1916. nhr. itj. 
Tba lalatioBaaip bati 



d 
1916. di, ai^ 



W. D. 



I9 t6. ip»r.43» 

raivit 



J. ObM.. X. Y . 191 6, body , 514.^ 
naddonda d aMRanr aoinaiag by aba 

tbaviVhto. A. P. W. MitLAa. Brit. MJ.. 
NriMai laoantfaaa. P. tA Toaaa. Cfa. 



C CaAas. Aat. 



ivBh ast. idt, JM. 



abaofpuoa Itoai 

"., 1916. U, 4$J. 
oMct.. 1916. 



G. Gtaaoa. Aat J. Obat^ N. Y^ 

F. Ilcaa. N. Y. M. J.. 1916, dv. 

fai tba tranintrnt d pdvk 
Wlk M. J.. 1916. IV, 1 16. 




BIBLIOGRAPHY OF CURRENT LITERATURE 



W 



OBSTETRICS 



and lu Complioiilona 

No<« M Ml ■■twMfl or pwfMary cttak at Um Edfai- 
buTfii Roval MatcfBlty Ilnipliri J. W. Baixamtymb. 
Brit. M. r. igi6. U. 410. 

Abdonuial prasMacy. B. SotoMom. Swf^ Gyaec. 
ft OlMt.. 1016. xziU. ij8. i««| 

iDtcntitial pragaaacy. W. Komlmaxk. N. Ori. M. 
It S. J.. iQio. Ixix. jio. 

Ectopic letsaatioQ. o. H. 
San., 1016. uix. iJS. 

tW cCialaor. fyaytoaailmy, palkokfy, aad ticatamit 
of two OMM of octopk ifftfaa. C ft. Miun. CU- 
CMp M. Recorder, 1916. xzxviU, ao9> 

CMe of ectopk pfcgaaacy vhkli had loac beyond 
(on tiaK. R. Jasiuxs. rieifoa M. J., 1916, iv, 1 j;. 

Twatmeat of tke cnMncagr CMCi of ectopk pfcgaaacy. 
R. H. RtauaDOOM. BwL JoIum Hopkiae Ho^k, 1916. 
szvi, a6>. 

Edaaipria, a prr\-eotAble diMAsc. J. W. Wukston. 
Mod. Rec., iQi6, xc. 414. 

P wyaaiieadprophyUuiaiBcdainpria. G.I.SnACVAic. 
Proctraoncr, Load., 191b, xcvU, 279. 

Tlw application of protracted proctod>-sb in the treat- 
t of edamnria. G. M. Mti 



KatsAtx. Intcmat. J. 



raoid evacvatioa of the uterua. U. FmuiBBt. 
mid., 1916, xziil, J38. 

Spoataaeooi rupture of the trtcrua. J. H. Tkl^aoi. 
Am. J. Ohet.. N. Y.. 1916. hudv. 401. 

Care of aormal labor. W. Van Nkttc Edect. M. J.. 
1916. LcKvi, 470. 

Abaoruml labor. S. Wicxaa. N. Y. M. I.. 1916, dv, 

j6i. mi 

Paialem labor. J. C. Kocab. J. .\m. M. Am., 1916, 

uvii. 719. m 

Results from pituitary extract in obstetrtc», with report 
of case of rupture of the utrru» foOowing its use. L. G. 
McNciu:. .\m. J. Oln^t , N'. Y.. igiA, Ixxiv. 4jj. 

Pucfperlum and Ita CompUcatlona 

Prophylaxis of puerperal coavuirioni S. H. Btoocarr. 
N. Am. J. HomcBop., 1916, zzsi, 961. (Ml 

Case of pnerpmal MprtoBmh fcoted by autofeaooti 
with recovcn 



vaociBe, 
454. 



reoorery. W. GaiSK. Brit. M. J.. 1916. ii. 



MiaccUaneoua 

Prolapsed intestine through ruptured uterus. E. H. 



Mayne. Am. I. Ofast., N. Y., 1916, Izxiv, 5i(. 
G. M. ifiMAY. South. M. F., Pdvic infection. A. J. WAtacHEiD. X. V. M. I.. 

1916, ix. 8i9- Iw^l 1916, dv, ^o. |«9) 

Lumbar punctjire for rdid of coavttlsioaa in puerperal * . - • .., *. %« . 

WiuoN. J. Am. M. Am., iqi6, lx>-ii. 



W. T 
741. l*7i 

Two cases of edampsia at sixth aad seveath month of 
prcfoaacy. E. Bilsted. Ugcak. f. Laier, 1916, Izxviii, 
1671. 

Rupture of the scar of a previous cesarean section. 
P. PDWunr. Am. J. Obst., N. Y., 1916, Izziv, 411. 

Two iaterastiag obacrvations on rmrture of the gravid 
uterus. U. FUramdki. PiOMa am., .\rgent.. 1916, 
iii, 117. 

Pituitria ia post-abortion curcttement. H. D. F(;«inM. 
Surg.. Gynec k Obst.. 1916. zziii, $6$. |47] 

Pragaaacy and arterial tcndoa. C. Doljam. Anh. 
de mat du arur. 1916. ix, 388. (§7] 

Labor and Ita Cooapllcationa 

Pnoaacy at term in a bicomate bicervical uterus. 
E. A. Boaao. Picasa mM.. Argent., 1916. iii. 88. 

Ddivery by ahdominal section. E. P. Da\is. BuO. 
Mcd.-Chir. Fac Md.. 1916. b, 3j. («7| 

LaadMT puacture of the fcrtus, during pedalic extrac- 
tioe, la the iaterest of the life of the ketns itsdf. R. 
CoarA. Gaa. d. o^». o d. din.. Milano, 1916, zzxvii, 
1100. 

1m prapor maaagcmeat of pbcenta pnevia. M. S. 
Davis. Soalk U. J.. 1916, ix, ij6. 

Etiopathofaamia aad treatawat of placaata praria. 
tta.s \NOBi. SoMaa arfd., 1916, xxiii, 372. 

Methods of ladadag the icdstaace of the neck ia the 



A case of wtra-uterine scarlet fever. R. M. Lttweu. 
and C. E. Tasgye. Brit. M. J., 1916, ii, 389. 

Race suiddc and eugenics. P. .\. Zabixc. Padfic 
M J., 1916, lix, 537. 

The abortionist. J. L. TiKMirsox. Yiig. M. Semi- 
Month., 1916, xxi, 7SO. 

The control of criminal abortioo as influenced by the 
present war. F. J. Taissig. intent. M. J.. 1016, xxiB, 

Biologic diagnosis of pregnancy. F. \. Delixa. 
Senuma med., 1916, xxiii, 307. 

Report of a case of general (rdema of the ftctus. H. C. 
WiLUAMSON. .Am. J. Obst., N. Y.. 1916, Ixxiv, 376. 

Multiple births. K. G. .Avcarrr. Med. World. 1916. 
xxxiv, 347. 

Multiple births; rqiort of a case of triplets. H. L. 
Read. Louisville .Month. J., 1916. xxiii, 109. 

Congenital multiple maUonaationa ia a stiUbora foetus. 
G. Flnaiou. Riv. di din. PediaL. 1916, dv, 419. 

The hunch-back or gibbons pdidc D. B. ILutT. 
Edinb. M. J., 1916, xvii, 15a 

A child wei^iiog twenty-five povadi at birth. D. P. 
Bsuaxa. J. Am. M. Ass., 1916. bcviL 950- f<^ 

The rdatioo of lacUtioo to tuberculoda. H. F. Lamc- 
BOBfT. Med. Rev. Revs.. 1916, xxii. 67^^. 

The nuise-midwife. F. J. TAi-saic. Wis. M. J.. 1916. 
XV, 113. 

Keepiiv ahead of trouble in obstetrics. W. L. Mabks. 
Edect. M. J.. 1916. Ixxvi. 458. 

CoaaervaUam in obstetrics. E. B. CaActx. Mod. 
Proa k Circ, 1916. cii. 214. 



INTERNATIONAL ABSTRACT OP SURGERY 



OBNITO-URINARY SURGERY 



Ufttw 



Am. J 
calral In 
AickRadlaLft 



tJCtLtmm, VnL 
iUv^ toti, BK. fot. fTQ 

«f bMdw •«! wvtknl 



Kk RmMoL ft BhctMllHnip^, i«i*, at. lof . 

Om klMl ol hmham Am le IMwr iImml f. 8. 

CtaOtlTT I'tvi ft CmUL RCV.« |«|6, a, JM. 

OtiBiiiit !■ 10 Um aivdljr of Um mmm aad Modi of 
ilMkiiMr. COaiMntA. GIsr. d. r. Aecad. « m«L tf 

KJdMV voMdi. H. Umk. Brfl. rt mte. Soc. dt 
cMv. dt rar.. i«ift. dl, t»»i. 

KId—y tiBwirrlii^ dw to kidMjr coatwioa. Cast. 
niiilii Md. WdMKkr^ 1916. dtt. iiM. 

DiMMrii Mrf MBrisri IfnUMBi of ■■Ij 

•f llM UdMT. bTRby. T)r. XI Nortk 



el WIm; UM Mpmotv ppvcr gi 
llMUidd«. LMmm. ClikcyrniSi^ahr.tit. 

fallKlioa €f dw bbddw. E. U. 



^ A. Nqoohba. 

tW Inooqrt* cswrt to Um Mily Mat* of I 
kUMjriaiMMMttoa*. GsArv. DnrtadMi 

TW Mlfcatagkri MMloaqr. ■I'liln— . mmI dtofaorii 
«i wrf lit II Mil Ik. L. J. RoraT Cklkf. SL J. Had.. 



N. Y. M. J.. 1016. dv. SSJ. 
MidMlMi el wtat: iha NpMM 
I 
Fl u owMronte niNipii ngeGuaa ei um MMMer. k. a. 
SuK'KKa. Sunt . Gjraac ft Okal.« 1916. tsUi. j6i. 

A OMlbod ia Um opMaUvt twataMwt of «iUoal||r el Iht 
bladder. T. Umrnmo. Tr. XI Nertk 8«i.. Ce^ 
OoeUbe%t9t«*J«d)r. I'll 

A hiaddM eatara. A. R. Pmoool Soif.. Gjraa& ft 
OtMl..lOtd,SBiii,jft4. ^ ^. . ^ ^ ^5fl 

Bnarieacai ineiiMi^ Iha dWeri vriaa «f GeM- 
•GBMaoi • peeMnar amaraacopK eHiMaanes. a. rawa* 
Tr. XI Nartk Saig. Ooas^ QaaHboti. 1916. Jaly. 

\ of tha afalkial utoadt aad oyptEi 

Uf«L ft 



aiady of JimiM of the afolkial itoadt a 
N. B. Ammram. km. Mad., 1916. sL6a^ 
CerciaeaM of the peak S. C. Mc6ov. 



191^ BV( jM. 
OMa of MB 



r, 1916, 



Calaa. Rev.. iot6. n, 4B1 

GaoltalOrtaaa 

A caie of leMkk giafUag wiUi uartaertad 
R. T. MoaaM. j. Aol M. Aa*^ 1916, fitvO. 74<. 
UadeKaadad leMk D. N. EuaaDaATa. Aaa. 



Pkfla.. 1916. Uhr, s»4- 
A caae of trfiM c a lorie of Um 



Sl M. Am.. 1916. to. 
of 



Aai. j. Ok CUM.. 1916. lit, tif. 



u H. O. 

J5I. 171) 

R. M. SHmL 

NcBkfilk uaatad by daalle ihrejMaliltoB of Um 
UdaS^ J.CBauM. EdUk M. J. 1916. ivU. t;9• 
A caMaaialiva etady of laM* ier raaal f aac 

of Ibt bfced. AiBaid^ rniariiSt 3 

the taM-aeel for laaal faactfaa. H. O. MoaiMnuL aad 

D.S.Lc«». J.AaLM.AM..i9i6.tovlL9Sl. 1^1 

ScheaM of Um laaal faacUoa. B. C«auist. Rev. 
fla. de dk. tt da Ibltap.. 1916, an. 644* 

Sliktaiaof tbeaartcr. G. L. Rmnota. N. Y. M. JL 

HMa wa il a to Um tiialBMal of aielaal calcahM. 
H. W. E. W4tT«t« UnL ft Cslaa. Rev.. 1916. n. 



.Vtachn. 



ILSCBUUMO. 

1916. jaly. 

Panto 

He oonact totaipriuutoa of bladdar ■ j r a yle — , J. 
W. PkiOL VnL ft Caiaa. Rev., lot*. as, $»t. 

Dhaetaa of UMtoawto Madder. lUrdliVMria. R. B. 
9nwA». VnL ft Caiaa. Bav^ t9t6. ai. 40. 

to aipMi. affali Medal leJewaca to 



*l* 

e iddMi a d i uaated bgr 
Duraala'B BMllnd. A Soeu. Gan. d. 9^ • d. dtob, 
MDaao, 1916. ixxvii, utQ. 

PrioMry pirrithdUl HUtoaM of HMnnalk coed. A. 
BaAMD. N. Y. M. J.. ioi6.dv. 454. 

Aa uaoMal hytfaocdo oooieaL J. Eboq oi . Saif.. 
Gyaec. ft Obrt., 1916. oitt. j6a. 

A cMe of ehdonrfaal or Utocdar bydraoda. P. Ol 
LAsaaav. Brit. M. J.. 1916. U. 991. 

Bbahdemioiiw of the pcortatc. J. B. SqonBL BaiL, 
Gyaa&ftOlat.. 1916. uui.Mi. PM 

Pwetalartaay. O. BoacMoasviMS. Tt. XI Kortk 
S«e|. Cent., Goetaboff. 1916, Jaly. |7ij 

SooM tbootbts o« prortatactoaqr. H. H. Moaroa. 

'^nf ;■?? ; rYiiM '^imiilfiS aadar tbe 
dfcaaMkMet. Loombao. J. de add. de 
1916. IsnvB. t4$. 

RoMlto after pRMtatoctoay. I. D. Loaaa aad R. W. 
Ka^rr T Mick St. M. Soc. 1916. xv. 4j$. 



tartoiito( 
W.B.MacNi 



lakirki of tbe artoaiy tiacL It J. Wouamb. 
MJ.. i9i6,to.«JO. 
llMMfilcal problem of aalalanl evMBioadeM baaSF 
' ' lidkt. B.L.PAvim,JB..aad 
, M. Am.. 1916. tovtt. 9ti. |7I| 
of tbe pirtoMi ragka. 
T. Laobwil Oaea. aMd.'di Rn eM. 1916. dll. 191. 



J- 



BIBLIOGRAPHY OF CURRENT UTERATURE 



99 



SURGERY OF THE EYE AND EAR 



«y« 



lUpoft ol • caM of mtitmamgcomm of Um orbit trauod 
villi iirtl— E. B. Haocn. Aick Opbtk. 1916. ilv, 
t6c 

RoMoval of a lanor at Um opts of tkc orbit, witb 
f ■Bnntkw of the eyobal, ia a case of nloEifonii n c uiw o 
of tW cyolkL A. Riurr. Aick OpUk. 1016, xlv. 47s. 

War injuries of tlw vimol appoistm. P. Kmatt. 
Cor.-bl (. Miiwoii. AcfBU, 1916. dvi. 11S5. 

Priaao* tnhercuhwii of tbo eye. F. Loauwco. Cast, 
aod. dl KMM. 1916. rii, <sl. 

BipwInMwtal gnarfn— !■ in tbe ocdar timum, O. 
Vaul Gior. d. r. Accad. <U mod. di Torino. 1916, bods, 
j6ow 

StadiM of opik-Bcrvc atropby in ■»odilioa with 
chiMBal Moaa. C B. Waucu and H. Cvmmo. 
AidL Ophth.. 1916, xlv. 40^. 

TfeoattMat of penetiaunc injuriei to tbe eyeball. 
H. W. WoooBcrv. lUioob M. J.. 1916. zxx. i8t. 

RActioM 00 cataract extractioo. E. A. R. Ncwiiax. 
Indiaa U. Gas.. 1916. xi. jii. 

Improved cap»ulc (orccpe for intracapMilar cataract 
extnctfaaft. F. H. Vcsaoarr. .\rcb. Opbtb.. 1916. xlv. 

lavMtigatioo of tbe vinMl 6cid in operative glaucoma. 
G. J. SancTX. NedcrL TIjdKbr. v. GeaeedK.. 1916. U. 
laoa 

lliwm bair witiiri for tbe relief of tcarioe ia g laiio o ntt , 
J. W. Sana. TB&mm M. J.. 1916. xxz, 179. 

Atoaic leaSc ect t opioo treated by grlatlfr opcsatioa. 
G. SboccM. J. Mich. St. M. Soc.. 1916, xv. 434. 

Qrcular plMtic of evdid in cicatrical ectropioo. E. F. 
SmrDAc-KEa. DKaoit M. J.. 1916. xxx, 186. 

Tbe dj^tanertr vahie of tubcrde of tbe cboraid. S. 
S iEfaj a u w. Laacec, Load^ 1916. cxd, 472. 

of tht iatarpe da acaiar recioo. H. L. Puua. 
bM.. .\ifcat., t9i6. iU, 117. 



Operative traatamat of Usb myopia. L. H. Vax 
RoMt;MML Nadort. TtjdKltf. v. Goaamlu. 1916. U 
toil. 

Tbt tnalaMat of tfachoaM by Mdrfoa of tba lamm aad 
taaal ooajttactiva of the upper Hd. W. E. S. Mowtbict. 
laAaa M. Gat.. 1916. H. 994- 

Bdolocy of ocdar wooadi bi war. V. MoaAX aad F. 
MoaiAV. Aaa. d'ocaL, 1916. ittii, jii. 

Tht aaackatioa of the eyeball aad faulty tirbainae 
mwaerifrfy ooaiidmwL T. J. Diicit>y. V. OiL M. ft 
S. J., 1916, brix. 105. 

Ear 

Tbe diKha nia f car. A. Baaocs. Med. Rec. 1916 
«c.$88. 

A caaeof cerebdar otitic alaccm diagaowd aadcand. 
G. GaancMioo. Gior. d. r. Aocad. di med. di Toriao, 
1916. bads, 145. 

Suppu ra t i ve mastoiditi* — a iai|ical tmu^mcy. F. J. 
PcTNAM. J.-Lancct, 1916. xzxvi, 531. 

Acute maetoiditi*. .\. E. JoamoM. J.-LaaocC. 1916. 
«xvi,sJ7. 

.\cute mastoiditis and facial paralyn*. GaAOCsaooi 
Gior. d. r. .\ccad. di med. di Torino, 1916. Ixxix, 34$. 

Old and new critidima of tbe operative treatment of 
mastoiditift. G. GaAoaxiGo. Gior. d. r. .\ccad. di awd. 
di Torino, 1016, Uxiz, jji. 

Acute middle ear suppuration. J. J. O'Bbiex. N. Y. 
M. I., 1916, dv, 649. 

Note on tbe value of hiwamiaa ia aural suppvmtiaa 
aad in meningitit. D. Gvnnix. Brit. M. J.. 1916, B, 

455- 

How can we meet tbe problem of tbe deaf? H. Hats. 
Intcist. M. J., 1916, xxiii, 779. 

The aequdc of oral fod of infection. C. D. LtKAt. 
J. Indiana St. M. A».. 1Q16, ix, 361. 

Tbe cioaure of tympanic poforatioo. .\. Sowui. 
Cbnique, Chicafo, 1916. xxx\'ii. 4ji. 



SURGERY OF THE NOSE, THROAT. AND MOUTH 



SyaoloaM 
H. LWAitw 



None 

Naaal ofartractioa. E. L. Wabux. St. Paul M. J., 
1916. xvfii, tTS. 
S y pto— aad tfiafit of the def ecte d naaal septum. 
Tana St. ^. Ma d.« tyi6. xii. «j6. 

r iafactioas. P. WATsoK-WtuiAin. 
lfad.Xhir. I^ 1916. noiv. u. (791 

The rdatioa of mmtm of the a c ce a ao n r riaaaca to 
diitaaw of the eye. aipachly ia chBdrea. J. H. Bbvam. 
Tt*. AaL LaryafoL Aaa.. Waahtagtoa. 1916. May. (79) 

Caalcrsof metaatatic iai ac t loaaia the upper ra^iiratory 
tract. W. J. RmooT. IHaoia M. J.. 1916. xn. tSo. 

CaidaooM of aatnna. G. W. Boor. J . Ophth. ft Oto- 
Laryngol., 1916, a, aft. 

Thit trcatmeat ol amxilbry siaaa dktmt. C. F. 
TaxttKx. .\lbaay M. Aaa., 1916, mvtt, $64. (M) 



Acidoaii; its importance in na»c and thrust »uricrr> in 
chfldrca. W. H. Juhxston. Laryngoscope, 1916. xx\-i 
looj. Ml 

Improved technique in my new submucous op erat ipa. 
O. TYtnxca. lUioois M. J.. 1016. xxx. t6i. 

Extensive cbdesteatcma foUowiog the Luc-Caldwcfl and 
Killian operations, simulating sarcoma. V. Dabxxv. Tr. 
Am. Laiyagol. Asa., Washington. 1916. May. ^| 

Spun in the nose. J. C. Wakbuck. Baflalo M. J., 
i^te, lxxii,6i. 

A acptal ^dint. C. B. Walkkb. J. .\m. M. \m.. 1916. 
ljnrii,874. 

Throat 

An epidcadc of a severe form of acala JafKtinn of the 

a with abaccM fonaatioa; report of fftv-eight 
la. C. F. Tanasjt. Tr. Aau Laryafoi. 
.toa. 1916. May. 



mi 



toe 
A 



INTERNATIONAL ABSTRACT OF SURGERY 



M«ttik 



tl tMtfM d ImnkmUm iwkm. %. 
ttftk %9^ ■WV mI^ |H| 





j.CtLAwnM. MTlMMMJi 

C |. WSAUD*. 
Ifcl MIllHIllIll rf til hlWlM III 

hi ittm. T. R. FfencB. TV. Aml Lup m L 
Z Mf%cWainaB. J. QpML ft 
TV «^mUM l« wprd «f taHRk D. L. R««ru. 
Maiaa aMdMii «l loMaKiHiiy mi IwiiiMwti 

AIMHB d IW iMJalMWg «p0Mli«l o« Uh iMMb Md 

ippsairmct. C. W. RnuiMoii. Utyig—pt, totj. 

nv^ MM. I**l 

A iMMMl «l aqr jTMt^ ««lt «Ml mmhIm 
Mpf. ILCLrars. Tr. Am. LMyifrf. Am^ Wi 

killw IvyilKMiyMd sad MMlli d 

dt dM. mM. 4* BuoL 



cur.* •••*«€«■. ill* 

«l !>■ afctrjfi aad larjrms. 



MartloM ud ihmi 
. y Am M. Am., m^ 

tkt aOHtb Md lkMII> 





Ml*. 

«•■ CMMd witli tlM 
Am. Uryifal* Am.. 

of IW 
rahtioaaf tht 
W. S. B«v4»r. Had. Rac. 



bTr 

Mvnn. M«d.. CoMd. i«i6. nl, tf. 1M| 

Mimi. 



T. 8. 



CM. SI. j. 



A.J.WkneT. M«d.|.AMMI. 



fwiodoMal Mplk foci 
]d«d.«rai6.iriv,isft. 
OmmI tattaum ami tymmak dbMM; ti 

B. R. Lnm. J. Am. M. Am.. i«i6. Iivg. •«!. 

MUl nigMMa. j. B. 9lBM. JS 

I yWIHBB MWBMISb 

1916. U. I ji. 

PyoniMm alvMlMfe. D. W. KftAwui. M. V. M. J . 
1916. dv. 415. 

Tlw pMiMl iMtM ol alveoUr <m> uH i j (dl U i (pforriHM 

■IVMlMiK); to MMM Md IfMUMM vWl IlI'dlB 

L. S. MuMini BmMa M. R S. j., M16. dnv. jft?. 

PUiMt dMwiM MMlt of plMlfc of Uh ckMk villi MC 
of llM IMMW. w. Vak Hook. CUmid M. Romdw. 

DoootAS. A«k Smb., PMIi . 1916. Ishr, jftj. 

P— clMO loBowod^ lovafi m o dlojiniiir Molkad io 
■MiMMir oMpfOMk A. S. Lmxmauoio. 
I9t«. nil. sst. 

HanipuddclipoUtc. T.E.CAunov. Sooth. M. 

t9i^ is, 744* 

PMtortMdyof IMMM of tho wndo, < 
fnqwaqr. Milfnoacjr. aad i o cm w mo . P. S. 
UffyagMMM t0i6, sxvi, 107s. IMI 

AdMopHMMOo wtoh oMoopainUtk of dartol anfjuk 
cMod h JM doM by MMocm iIwImm H.OunrT. Bol. 
flC aiM. Soc «• cUr., Piw., 1916, m, >m7- 

lyiwtdiidi ol tht lai«M. J. R. Soorr. Am. J. M . 
8c,Mi6,dH,4si. 

CytirfraaM of tlw toogoe. R H Bmool 
Gyooc R CNMt.. 1916. nffi. is^. 



INTERNATIONAL 
ABSTRACT OF SURGERY 

FEBRUARY, 191 7 



ABSTRACTS OF CURRENT LITERATURE 



GENERAL SURGERY 



SURGICAL TECHNIQUE 



OPERATIVB SDRGBRT AKD TBCHHIQUB 

E. E.: The Um of Salt Solution by the 
(Morpliy M*tbod> in Infants and 
^rck. Pediitt., IQ16, xxxiii, 775. 



The author regards the infusion of normal saline 
into the bowel by the drop method as a most valu- 
able aid in the treatment of all the exhausting 
dimtct of infancy and childhood, and believes 
tluu hy its stimulating effects threatened collapse 
caB often be averted. In feeding children and 
infaatt who cannot retain nourishment given by 
mouth, a nutrient enema given drop by drop is 
often better retained and alMorbed than when given 
more rapidly. 

The length of time proctoclysis should be con- 
tinued varies with the aspects of the base. In 
children, especially, it depends upon how they 
tolerate the presence of the tube within the rectum. 
In infants tDe mere fastening of the tube to the 
buttocks with adhesive strips will suffice, but older 
children must be perraaded to allow the tube to 
remain, for it may be so annoying that a sick child 
will try to pull it out. 

The usual duration of this treatment is from four 
to six days, but if the rectum is not unduly irritated 
and the indications warrant, proctoclysis may be 
kept up with interruptions for ten days to two 
weeks. 

The author reports the case of an infant, 35 da^ 
old, who had severe jaundice and frequent vomit- 
ing. It weighed at birth 9 pounds, but when seen 
b^ the author wctfhed 7 pounds and 14 ounces with 
duper on. The stool condstcd almost entirely of 
dark mucus. At times the head was retracted 
and the spine arched. The child was dull, drowsy, 
and appeared to be very ill. It was placed on salt 
solution and in one week appeared much better: 



had gainr<l 4 
had gained i 
steadily. 



ounces. 
|x>und. 



.\t the end of a month it 
From then on it improved 
EOWABD L. CoaxcLL. 



HUl, R.: Posture In Abdominal Dralnate. Tr. 

Weil. Surg. Alt.. St. Paul. 1916, Dec. 

There are three recognixed positions in treating 
these cases: (i) the Fowler, as advocated by 
Fowler and later by Murphy; (2) the prone position; 
and (3) the lateral position. 

I. The Fowler position tends to throw a decided 
strain upon a patient with an already weakened 
heart and lowered blood -pressure. Moreover, as 
the pelvis is lower than the pubic bones, drainage 
takes place by syphonage. 

3. The prone position, as used quite extensively 
in the St. Louis City Hoqiital, is carried out by 
placing the patient on the abdomen with the head 
of the bed elevated 10 or 12 inches. A pillow b 
placed under the lower part of the chest, and one 
under t he head so as to give ample room for brea t hing. 

The principal objection to this position b that it 
is not comfortable, but obser\'atioiu ihow that 
it is not so uncomfortable as one would suppose. 

By this position the maximum effects of gravity, 
intra-abdominal pressure, and capillary attraction 
are secured. In addition to thu there are no spaces 
in the front of the abdomen to favor the formation 
of pockets, as there arc in the pelvis and along the 
side of the spine. Pus is also brou^t against an 
area of the abdomen where blood-vosels and Iprm- 
phatics are not so numerous as they are in the pelvis. 
This is considered a very important fact, as it 
would seem that absorption would take place more 
slowly than in any other part of the abdomen. 

J. The lateral position, in which the patient it 
placed on the right side in a slightly ele\'ated posi- 
tion, has been proved mo»t efficient. 



101 



lOi 



INTERNATIONAL ABSTRACT OF SURGERY 



tkmn 



iW 104 dntmm iSMdh csmb, opmud 
•I iW 81. LMb Ckjr Mplul la Um pMt ftv 

Um tiMtt pmIumm wm MMloytd villi 
fwqpiacy t« wuvut ite foftovfait coa- 

10 M tiM frfiiNi MMriu «f mkIi: 
la Um IS ctMi tfwitd la tW bitral poAloa 



«f 4a CM« tnti«d fai Um I* oat 
taN tdwilw 



tiMt 



talW 

tlHVt 
OftW47 
S 



tnattd fai tiMFbwIcr Miitioa 

AH CMM ncchffd iw mi 

!• BOMlditid to bt 



aatlMrIi cbIbIm frani Mi opcriracr. both 
la private tad paMlc iaiUt«Uoai,b Umu ibt poMvrv 
la vWdi a pautai b pbflid coatribalM aMtcrially 
10 lb iMovtry, sad m abo bdbna tlau tlie prooc 



Fovbr. 



•It bhkIi 



ASEPTIC AND AimSBPtIC SOKGERY 

P.t New So^raa cIm Action ol lljrpo- 
(Koovfin 4l«d« MV Tactiao da bypo* 

•on- 

•tadbs oa tW actioa of Dakia'* 



■aM w 
abMt^ 



ivt Uai tlw ladkatlom ia caM of 
«, bitctad oaljr. tiMt b b wiricli adcrobo 
abaadjr cn i o a iiiid TV pfmat ttadht have 



to diCcnaiae bow hvpoddoriics 
act la iht caM of fiwb «ooads aad wIMcr tbcy 



aia capable of puitwllaa tbe dcv d opai ci 
BdaobM. H«bMb«afiMbbdtoaMko(b« 



rat of 
Mudic* 

ia tbt ■aibabara wnrfca coadactod by Primgladf 
Of 99 voaadi wbich DdbM aaaOaed fai tbe int 
low boats after bUanr. fai oaly j ooaM be ftod any 
la tbe bcpBBiag aad focb woaadt were 
by tbcU or gicaede. Oaly 11 of tbc»e 
' coold be foDovod. AD tboe were treated 
by eoa^dcte imrtinii of tbe cdfes tod walb of tbe 
wmmA foloaad by intemiittent irrigatioo with 
Dakia*itaid. 

la tpbe «f tbe very favorabb cbonattaacee and 
tbe fact tbat faioof^tJ 
ivveabd bcfoio tioataMat oaly t of tbete 
■eapllf. aad oae of tbcM aoc abnhitcly to, at tbera 
wat oae poeilive pyocallaie. 

Tbe evefauloa of tbe by po cbl orite ticataMat b 
aoicd. At int It wee oahr a awdlicatioa of Labar- 
laqae'e iaid vbkb loadcfod ll Imo irritatii« by 
liihM iioai It a pan of ha lalbiptfc power. In 
Ibb iM pbMe of ka aw It wao roaridiwd by 
Caml. Dakia, aad ocbm tbat tbb Said aloae wao 
of iloriHriac woaadik Tbcre wat tbea ao 



ap tbe woaad. Ia tbe tecnad 
of ouly aad laift opeafaifi was 
•howa. wHdi wao to a max ottoat aa avo«ral of 
tbe faBaie of bypocblome actioa aloae. Ptaalhr. 
tbe precike of fmirtJoi woe adoplod. the wboie 
lo^leciovy of tbe woood bdaf l aw ct t d aad« 



la aU 



tbeet cbaaflM tbe bypocblorite 
tbe cbat^iMM bi iW fldfiaa 
lyfaM ka «•. tW aMie fovoral 



Ibvofabb 
be aocribed ta Ibt 



bat 10 tbe wfaMe 
Dilbel poiott out iImi a number of 
at pwaint tVMibui ibcir wouade by wm6 
•aiBcal deariaf of tbe ana* nmciIoi^ aad 
dbM loaaioa. W. a. 



"rt:, 



AIIA8THBTIC 
F. i.t Aw— tbwlo K. r. M. J., 1016. dv. 



In order to farflitete the teaching of tbe art 
of aaMtbeeia« the author offers a 
whicb 



to the 1 



(1) 



vhicb coBiblnra the iiadiaai of tbe pbyilological 
aboratory aad Ibe oporottat roooa. Tbeie aio 
three priawiy dhrUoat: feaml. locd, aad tpiaol 
aaBitbeoia* There are two doBioeo of 

Krnenl ■na^thiab ooariillac of three M , 
ioductioo; (>) Bialatcaoaoe: (j) rriitetioa. 

Tbe firit ttafe rnaibti of three periods, ocilo* 
ment, rigiditv. and rriewnion; ibe lecoad aiay be 
of t wo varietiea, constant aad variable aMintcaaace; 
while the stafe of r e c ove r y b divided iato two 
periodi, return of the rrfleaet aad relani of con* 
■rlnuMiiai, Two tjrpes of r ecov er y are aeca, leoov- 
ery by oMi aad recovery by lyiia. 

Wbeaoncb a doMificatioa ben^lloved, tbe tine 

beh a vior of the pupfl under ether during tbe ttage 
of induction, maintenance, and recovery may be 
spoken of with the aaaurance that the time ipecliMl 
wUI not be m i sun d ers tood, while muxruUr rolote 
tion becomes a test of tbe worth and rliicbacy of 
the general anesthetic E. K. 



And«rwKNi. H. C.: Anttbseie by Wslsctiea. /. Jf«. 

Si. U. Alt., 1916. siii. 477. 

In addition to tlie usual requirements of any 
anesthetic, the following factors should be taken 
into account : 

I. Tbe wishes of the operator as to the depth 
of the sni'ithMh 

a. Tbe history and fi m diti ff w of tbe patjgatt o^te- 
dally as far as neart leaioas are c oac orn o d , arfUal 

Tbe iBwetbitiH's itipiWMMiilly do« aoc ceose 
with tbe teradaatloa of the laaithioli. the awat 
important factor bcfaig the amount of aaaetbeab 
wUch b b the oatlMt's qrstem at the tioM ho 
leaves the opwitmg room. No op enti o B roquiioa 
aay neator ikfll thaa the odaaabtretioB of aa 
inaathetb lor a ladladtoasS aad idwidd operation, 
the kttor beb« a major ^p«atioa as far as the 
patltat b coaovned. The ase of mo t p b ln r and 
atfoplae fnatfar aids a asaoial aaMthmb if pro- 
perty tbaodrir B^imoditiiM tevtoe tiaiMe. It 



bat It shodd aol be aiid la 



GENERAL SURGERY — SURGICAL TECHNIQUE 



»03 



the doM be the leine. Tbote who have nUn ihoiikl 
be given morphine. a« well as thoce who have no 
paia and a normal or dilated pupil. U no pee- 
operativc pain is present an<l the pupiU are con- 
tracted, morphine khoul«l be withheld. 

3. The duration of the operation must be deter- 
ntocd and the amrsthetic cboeen which will be the 
least harmful. If chlorofom is used as a preliminary 
to ether, it is sale if a sli^t Trendelenburg poaition 
it aUintainrd. 

4. Freedom of choice should be left to the 
anaithetbt. While ether by the drop method is 
the lafcat of all anesthetics, it b the moat uncom- 
fortable of inductiooa. Thuuxh drop ether is 
practkallv imperative in long o|)erations. it should 
be preceded by some more comfortable method 
of anesthesia. 

Nitrous oxide oxygen is the method of choice 
for induction, being many times less dangerous 
tlum chloroform and ethyl chloride. In gas oxygen 
there Is a sale and efficient substitute for "twilight 
sleep** and a valuable addition to the anesthetist's 
armamentarium, but not as innocuous as would be 
eiqpected. Very even anesthesia is essential to 
prevent trouble, even in minor operations. The 
simpler the machine for its administration the 
better, while after the first stages have passed, air 
is better than oxygen. 

The use of local infiltration with novocaine is of 
value in le&sening the responsibility of the anes- 
thetist, as a general anestnesia can thus be main> 
tained in a very superficial stage throughout a long 
operation. Intniphar\'ngcal anesthesia is of the 
Vimost ^ue in tnc plethoric, thick-necke<l patient 
who b laboring for air, who b cyanotic and who has 
large amounts of bronchial secretion to prevent the 
proper absorption of ether vapor. The introduction 
of a hard rubber tube into the phar>'nx produces a 
startling change, the cyanosb disappearing and the 
anesthetic p rogres s ing in an uneventful manner. 

£. K. .Xkustkonc. 

Cnlsai: GeDoral Aaswtheate bv Direct Intubation 
In Oparactoos upoa the Head and Neck (De 
raocsthfaic ginfrale par I'intubatioa dirccte dans 
Ics op^ratioQs sur la tdte et sur k cou). BmU. Acad. 
it mid. Ptr., 1916. Ixxvi. 345. 

The new method of anesthesia proposed by Guises 
depends 00 the fact that it b possible, by means of 
a special sound introduced through the mouth and 
witn the aid of direct laryngoscopy, to admiobter 
directly into the trachea a very exactly proportioned 
mixture of air and chloroform. 

Thb prooedore b quite diflcrent from the method 
of anesthesia by insufflation employed in the 
Unite<l States, in which the anesthetic mixture b 
insufHated into the bronchi by means of a special 
apparatus, expiration being inade through the free 
space between the sound and the bracheolar^ngcal 
wall. In (tuises's method inxpiration and expiration 
are done directly through the sound. 

Preliminary narcosb b induced by the mask in 



the ordinary way. When this Is complete the head 
b placed in extension and the tube introduced until 
by the aid of the laryngoscope it is seen that the 
trachea has been reachea Amesthesia b then eaaOjr 
continued without intemiptJoo imtil the end of tM 
operation. 

The advantages claimed by the author for the 
method are: (1) The chloroform generator b 
removed from the operative field. (>) There b 
considerable curtailment of time of operations 00 
the mouth and pharynx. In such operaticms ft b 
now custonury to |)eriodically administer the chloro- 
form and to suspend operation during these periods, 
(j) It b no longer necessary to pay attention to 
what American authors have termed the "death 
space." There b no doubt that the majority of 
deaths from anesthesia arc directly or indirectly 
due to the purely mechanical obstruction of the 
region compri.se<l between the mouth and the 
larynx. (4) .Ml danger of vomiting in the trachea 
or of aspiration of blood in the air passages b ob- 
viated. The author does not admit any disad- 
vantages. W. A. BKX.XXAN. 



Johnson. W. M.: Rectal AnsMfhrnia N. Y. M. J.. 

IQ16. dv, 846. 

The dose of ether for rectal anesthesia depends 
upon the age and weight of the patient, about one 
ounce of ether being required for each twenty-five 
pounds of txxiy weight. This may be lessened when 
paraldehyde is used. More than 6 ounces of a 7S 
per cent oil-ether mixture should not be given to 
adults, regardless of weight. The ocular reflexes 
should never be abolbhed and stertorous breathing 
should not be allowed to continue. These are danger 
signals, indicating the withdrawal of one to two 
ounces of fluid from the bowel. M the completion 
of the operation the colon should be irrigated. 

Postoperative nausea seems to be less, fright and 
shock are much less, and the method b safe and 
easy of administration. It b indicated especially 
in operations on the head, neck, throat, or chest; 
in the obese alcoholic, and in the aged, because of 
bronchial irritation. It b contra-indicated 



in any disease of the intestines, pdvic operations. 



and in general laparotomies, because 
distention. E. K. AaionoNO. 

Cole, H. P.: Some Obacnratloos oa Local Ansa- 
thcaia. Tr. S»mtM. Surg, tr Cyutt, 4».. WUtc 

Sulphur Springs. 1916, Dec 

The author reports a partial list of major opers- 
tions performed under local anesthesia, many of 
which were selected becanse of grave cootra-indica- 
lions to general anesthesia. 

The Ibt includes t$ cases of appendectomy for 
acute and chronic conditions, drainage of pcfitooeal 
abscesses and ceneral peritonitis. There were a 
number of exploratory operations, enterostomies, 
and gastroenterostomies; 8 cases of cholecystotooiy, 
one removal of a forty-three pound ovarian cyst, 
one nephrectomy, and a number of thyroidcctoouea. 



h 



t04 



INTKRNATIONAL ABSTRACT OP SURGERY 




TiMn WM OM cMt of Mip«HlM of iIm nicnit aad 
oat vMMVil of M tMofrfr pila i lea; tko j cmm oI 
rwlkal ■imnlnn of ihr bmil. Mid j cmm oI 
«l ibc ftkuH TImv fwt 7 l*P*- 
■dtr local MMMtWila liurini 
villi BO HMifnMl monalliy and villi 
tWloii qf oat to t m ' ^ 

la tat MffMi 7 opcffaiMNM wtw pcffonaad oa 
piilwii la ilw im dtcadr. » ol ilMa bdaf aadtr 
!«• ytan of ap ww caar. • Uirv anUkbl aao* 
for h apuforatt aaat, oa iIm tldrd day of life. 

TWf* wart 47 caa» oporaicd on briwtca the 
a«r» of 6ftjr aad d gMi -oaf w . aIriom w duri vat y 
•dBcud for local aaaallMia bccauac of caidlo- 
or naal eoaua'ladkaUoaa to trncr»l 
_ tUt 0<eap vaa an cxientivc 
lor caidBoaM of um tiarBaai oa a patioat 

yiait of agr: nrnimiiion of llit OcWt 



lor 
ampaiailoa 



la a yaliiai •taktyHMt yean of aft: 
for iiaiwai of tiM fool b a pail«M 
m» yoait of afr; cMicyMoioanr for 
rupiuod pi Wadilrr la a paikai ifky'iwo ytan of 
aft; aoplMociaay la a patkai of ftfiyiwo; aad a 
caat Ifly-lfM yaan of afr la wMdb dnkcyatoioaiy. 
apptadicieaiy. aad ponarior ga n fa-wnmiomy 
waia panoraNa lanman "* mow wcshm. 

Aaioat ilM caita oparaifd oa aadtr local aaaa* 
llwola baiwfca tW ftfih aad aiaik dacadt, iWia 
wa» a mortality rale of 4-< par caat. 

There ««« one daath aoMiat the Mvea ai^Jar 
opcraiioiu iK-rfonaad oa tofanu in the fIrM dacadt, 
with a 14 Dcf trot BMWtaMty rale. 

Tht aolBor coodudca that the lelactloa of local 
ananthtala a* the •nanihcik of chokt la caota 
offering grave mortality riika, li a factor of laltCy 
loo potrni to he nrflcrtrd. 



SURGERY OF THE HEAD AND NECK 



HBAD 



C. M.t 
of tlMHaad 

ik two 
Tmnm*, 1916, 



of GmMhoc Woond* 



r mSf m 



ymn ago art our 



nd (Sapr» akimi caii di ftfiie da •rma 
drf capo). Cim. d. r. Atmi. 4i mt4 4i 
)|6. Int. «7t. 



Faaiaai ha* treated 51 goaahol haad wouodi in 
wm advaacad fWd hoapital. Of thatt catet 4' 
aMand aridria iha irM twenty-fbar hoaia after in* 
Jary; i> being in Mich a desperate condition that 
they died from the gravity of their injuries; 4 did 
not call far laianrcmjon; the other atarw a p toaipU y 
operated apas la order to piavaal laHCliva coayli - 
catioai. WteUa a few daya 9 ihovad ilpa of iafac- 
llaa aad were operated apoa tha tacood Ubm. 
Al ciaaial iaiarita wiihoat dara laiiilyaBMat tan 
aatvrfarcoocM. Of istaparftdalwoaadaootrated 
apaa aarl^ ihare waa oiqr 1 dtath. Of 8 caaea 
oparatad apoa tecoadarly for tafecthm. 4 died. 
Of penetradag woaadt with pcojectilr* impUnicd 
la the bcaia aad operated apoa cariy (here were 
S deaths^ Om catt which was operated upon late 

Tha iiaalla thmr iht advaaiage of oaily lattr- 
ftailaa. lib la tha laiMthI (actor of aaootM la 
aO mrh woaada. Rapid tiaaiit aad advanced 
•argkal poau for tiaataMM of haad iajarka will 
be tha aaai ificarlBi OMaaa of chacUag the 
monaUiy fraa ta^ I^Jarita. Vchcr who opoatcd 
ia from two to lb hoasa after injury wm able m 
•how 51 t acotarita far 9 daatha in an automobile 

W. K. BaaxKAM. 



with 

Umyat^mmpt. i«i6. sxvi. 11 ft. 

Tht aaihor hat obMrvrd over 400 cam of caaoer 
af tht htad aad aach in the laai iwcaiy yaaia aad 
ia diagaoria or uaataMai of 



the diaeaie. 

they «rere twoalT yaar 

combating tht diitaaa. 

Buchsbaum, workiag la co^Jaactkm with tha 
author, baa i o cc aadad la pow lag aa organism from 
carcinomau laia ovad at optratloa wWch haa a 
characteristic color aad appaaraace, whidi 
an r|>ithrlial tumor when injected into ad 
die with metastases and rapid emadatioa, 
blood gives positive Abderfaalden reactioo for caa- 
cer; the organism can be recove r ed from thtit adot 
aad others re-lnocuUtc<l. Other tesu are cqaaOy 
convincing, but the author makes no daia that 
this organism b the causative factor of caacar. 

In r^ard to diagnodt, the microtoopical aaaaH 
iaatioa of aidaad tlMoa b tht ooly pothlve method. 
The Abderhalden teal haa baaa u e n or m e d in aboot 
one hundred caaea aad fonad pontJve in 70 per < 



A complement -fixatioa teat haa been worked oat by 
Kobalter which b aaaloioaa to the Wi 



test (or syphilb aad glvaa a hichcr i ii tc aa l Mi of 
podtlva laactieoa than the Abderhalden. Thtuavla 
ha mo urochroaM tctt of the oriae haa glvaa a pod* 
tlva laactioa ia tht ariaa ia 6e Dtr ctat of aMH« thaa 



im- 



tlva reactioo la tht ariaa la 60 par ctat of 
joocaaea. Oiakal dlagaoda b ttlO tht 
portaat and tht aathor warm agdait ladagtoo 
tiflw waitiag for thtraptatk tcau to dulareallate 
cardaooaa fran qrphflb, or (or the uae of the X-ray 
or raittam to afbct a care. 

Radical aafienr b tht oaly ratioad 
of cardaaau. To giwrd 

the author oeea tht actual caatcnr 

of ihegrowth. Ha 

with 

for 

cavitici. 



fata ad of th e knif e for 
haa applied tht Percy 

tht aaaal. oral. 




ia vary eapadkfail ba 
ployad vidi §Dod reeabi 

^aaai tetaetat aaa oaaa 



Ten miBigrBaM of ra- 
the dose avaBahIa The 



I 



GENERAL SURGERY - SURGERY OF THE HEAD AND NECK 



los 



X-ny b ci even greater value in ihcae superficial 
tuiMn, and tbe ambor pntoibca at least oae er- 
ythona dote before, and fiveoriiz after eadi opera- 
tion. Diathemy has given strikinic resulu in 
cauiBg tbe disappearance of troc cpitbcltal growths 
which in tbe sutbor's experience have inevitably 
recurred. 

Badi ploMb that a ooounktoe be appointed by a 
■■ ^'t**— ** cancer sodety to nraminn aiid report on 
tbe rcMilts of every " new" cure or aid in tbe treat- 
ment of cardnoma which b advocated or "dis- 
cove r e d " by a reputable phjrsician. E. Fnaou. 



C. B.t Tan Gmso of Gencar of the Tooaue 
and of tbo Floor of tbo Mouth (Acerca dc dies 
awes de csacer de la leagua y tuelo de boca). 
OKMtalfffa, Madrid, 1916, xxv, 5J0. 

Soler reports these cases to illustrate the opera- 
tive technique followed by Trigueros of Madrid. 

Tbe procedures in vogue, buccal and eztrabuccal, 
of Wbitebead and others for the partud or total 
extirpation of the ton«iUc for cancer are insufficient, 
since the involved lympb-glands are not dealt with 
nor is the diseased floor of tbe moutb extirpated. 
Total removal of tbe tongue is not necessary, 
according to the author, and is a brutal procedure. 

Trigueros uses tbe suprabyoidal route, making 
Us indsion over a line which runs from the middle 
part of the ascending branch of the lower maxillary 
and follows tbe edge of the sternocleidomastoid and 
thence horizontally to the level of the hyoid forming 
an an^e tangential to the hyoid cartilage. This 
incision gives ample facilities for removal of such 
glands as are necessary, as well as tbe affected parts 
of tbe tongue and floor of the moutb. Details of 
the technique are described. 

Chloroform anesthesia is employed and minute 
postoperative care is bestowed. Excellent rcstilts 
were obtained in all the 10 cases operated upoiL 
Of these cases 9 were in males, and i in a feinale, 
whidi proportion roujt^y agrees with tbe statistics 
of otliers. Primary implantation of carcinoma in 
the floor of tbe mouth is rare. Wolffer found it 
only in 7 per cent of all cancers of the buccal 
cavity. In a collection of 37 cases the author found 
it in 2 1 per cent of cases of cancer of the tongue and 
mouth. W. A. BasiarAN. 

CnDsjiB, A.: Parsdental Adenocarrinomn fAdeao 
caninoms pa r ad en tario). Od^mlthgU, lladrid, 1916, 
xxv, 505. 

Gallego reports the case of a woman of 3^ 1H10 
was operated upon for a tumor of the lower nuuDUary. 
Three 3rears later there was recurrence and she was 
again operated upon. There was a second recur- 
rence after four yiau more; and then the tumor was 
provisionally disgnnsed as an inferior maxillary 
sarcoma. 

Detailed hbtological examination showed that 
the tumor was of epithelial nature with certain 
characteristics both of cylindroma and adamantoma. 
It differed from the first in that it did not show 



diher cubical or plain ccOs and csnedally in that iu 
conjunctive tissue had not undergone muttiidal 
transformation. It differed from the second type 
in that its epitheUal cells were cylindrical and there 
were no bulbous groopinp of cells. 

Such a neoplasm, a primary tttmor of the lower 
maxillary, ought to have a paradental epithelial 
origin; snd hence the author classes it as an adeno- 
caidnoma of tbe inferior maxillary. 

W. A. Basmav. 

Krsuschar, P. II.: Ankylosia of tb« Jaw. Imltnl, 
M. J., 1916, xxiil, 857. 

Kreuscber reviews 3j cases from tbe clinic of tbe 
late Dr. John B. Murphy, giving the cattses of 
the ankylosis (routes of invasion) . t he fou r t ypes of ja w 
ankylosis, tbe seven stages in tbe evolution of the 
operation for ankylosis of joints in general, disgnosis, 
and the .Murphy technique and its results. 

Tbe four types of jaw ankylosis are: (1) intra- 
articular bony ankylosis — true ankylosb; (a) in- 
tra-articular fibrous ankylosis; (3) sub^gomatic 
cicatricial fixations; (4) interalveolar buccal 
fixations. 

Tbe seven stages in the evolution of tbe operative 
technique for aiucylosls in general are: 

1. Tbe formation of flail-joints. 

2. Tbe restoration of motion in a bony ankvlosed 
joint by tbe interposition of musde and nbrous 
tissue between tbe separated ends of tbe joint. 

3. Pseudo-arthrosis developing after bone opera- 
tions in tbe neighborhood of joints. 

4. Tbe transplantation of pedided flaps of fascia, 
fat, and capsule with the production of movable 
sliding serous surface joints. 

5. Tbe homotransplantations of the articular 
ends and surfaces of the bone. 

6. Tbe transplantation of flaps of fat and fascia 
which have been detached. 

7. The interposition of foreign material to make 
tbe ioint. 

The fourth is Murphy's method and has given 
practicallv 100 per cent movable joints in bis work. 
It is applicable in neariy every joint of tbe body 
where the periarticular tissues have not been 
destroyed by previous operation of destructive 

Tbe four routes of invasion into and 
the temporomandibular articulation as 
by Murphy are: 

I. The most frequent, an extension of the sup> 
puration from the middle ear. 

a. An ostdtis or osteomjrelitis of the m s ndib l e 
extending into the glenoid cavity. 

3. Tbe metsstsses from fod of infection within 
the mouth or elsewhere in the body, or part of the 
general metastatic arthritis. 

4. Ankylosis may result from a transmitted 
trauma from the tip of tbe chin to tbe articulation, 
giving a traumatic osseous fibrous arthritis. 

Murphy's disgnostir points In ossc ou i or firm 
fibrous ttnion are: 



lo6 



INTERNATIONAL ABSTRACT OP 8URGKKY 



I. FUiicaiim ol Um kw on ibc uoAflccttd tU», 

Ml pCOMMWid SMf IM tlpfll Uw dikk 

9. WIms ilw palltM atuayti lo opM tlw 

iW iMili Movt fiwn iltoioi/toooiMlMii 

Md dtvteu • Uiut te Un dbtctloa «f 

b« Ml Iq^ tiM pdinili« tafw, ud tlw 
Mthrlyr M Umi tUt b wry wkIi nttiar. 

4. TlwmMctaiM Uw Mkylowd ildt 1 
•tfopMtd tlwioa UmoUmtmh. 

5. TIm dtoUMi bv ■mmummm f rooi ibt knrar 
•dfi of Um MiMMlir »idl l« iIm lovratt poiai m 
iW ruMMof UH |»w b kM oa the alTcctad lUe than 



I Um priflMffy itMll «■! ptffcct M ikt 
kiar btcont ibwitid aad villi ii ib* 



an oMwt 



MllttViiMt. 



A pvpMidicvlw IkWm b ommIc 
Um car, otMidtait fron om Mid 
•bova ibt ■ifOMi ki Cba balrlte 
ibt bvw bofdir of ibt MMM. T 



JttM fai Ifooi of pbot of boni wm faMttod 



Mctioaof I 
Mckoftbt 



MUMiM dOVBWUd to 

of Ibt lypwi TbbfaKWootbai 
fomid OS ibt isptrior mtribi of the 
for a dbtaaet of aboal lbiot4o«ftbt of an 



tbt 



aad iImi owm apvaid tUfblly to at to avoid 

bif Ibt ttMBOial aad orbfcwar bcaacbtt of tbt 

I atrrt. Tab b followed by rinwval of a 

n of boM wibtW bKb vidt dtai 

oftbtaMadMa. Gnal can orati I 

•01 to failoit tbt faMonal aajdnanr ai 

dotrfy blip ibt atck of tbt ■aadiblt. 

ibt braia. vblcb b la dott pmballyi am 



by 
bKbvidtcbar 
Gnal can arati bt 

antry wbkb 
lojory 10 
bnia* wbkb b la don pmrfwitey, anMt be avoid* 
od k tbbDtrt of tbt opocaUoa. A U'tbaptd iap 
of fat aad laada aboal oat hrb vidt aad two faKbct 
loai. vitb tbt btM at tbt apotr aMffgk of the 
b nfltcttd fnai ovw tbt ttauioiral mtude 
iato tbe boajr ftp left by the booe 
Tbt flap b raulatd la DOtitioa by a few 
caUM fotant at iu aatcrior aaa potltrior batal 
aaoti^ Tbt tkk woaad b aocaratciy doetd with 
kim lull duttd wiib Ubiaalb tahkdide. aod 
ttaltd viihcolkdioaoafMntorcottoa. A woodeo 
b kterttd oa tbt dbttttd tide to maiotak 
of Ibe BMkr totib to pceveot miiotb 
of tbt flap aatil it b btakd. Aay 
I bt aipmttd at iu Cm tvidcace. 
ibt t ip i ralhm bring rrpcaitd if atcoMtiy. 

TbtaalyfaBttm were noptnlod apoa with good 
ntalia. Tatn f aBoftti KnaKbcr ta)fi» 
caand. bmm Ikcly. fraa aol botpkc U 
t!^ *• pn pu poti Uoa. Tbt i pt ca k ti t 
iof faflara lolowias tbt flm optmloa 
Fwrilill ati aO tbt ptrintitani waa nat 
Ibt boat, (t) Tbtn any bavt btea aa abtorplioa 
of tbt laiinptMka flap witb ottiflcalina of tbe aewly 
fttawd rnaairilvi tinot; or tbt flap OMy bavt 
ntracttd Itaviac two booy aaifaoet to n 

CaatR. 



JS. 




tbt aatbar mortrd to 
k two cant of la«|t 
diftcta at Ibtaaiifcal dkfc of ~ 
Saatibnich. Afttr dkcMdaj ibt dliiat 
bt nportA the two cam aad ibt awibtd 1 
Flm a Gttt of tbt btad wai aMdt aad to ilk a 
pkit of baiak bora wat fliiod to a tbidratn of 
J auB. witb rflfhily ihinnrr r«lgr% it wat tbta 
tlorfliatd by filacina in abtolutc akohol for tbnt 
dap at bofliag woaid tpoil tbt tbapt. 
Oat can wat a gift of 19 witb a 
mydtfiaoat otttotanoon of tbt poikial 

afkrnnoval Itf I a dtftct of 7 to 8 cak Tbt 
of bora waa inmid aadtr local aamibtda 
aad wcovtry wat mtvoailaL Oat yiar aad 9 
aMMtiM after tbe opentioa ibe miimt wat ilk^i 
wcU and liad ao r t coii ta ca. In tlw tteoad cnt 
there wat oriaiBaUy a dun tagjoma wirich made tbe 
•liull bolae forward aod atany ptrforated it. A 
bony window tbe «iae of a baadwtiwnavod aad afltr 
tJte tumor waa treated witb b^kclkaa of poaaaka 
and carboB dioxide toow it db a ppt a n d tatlrely. 
Tbt 7 by s cai. defect waa oovtnd witb a plau of 

Siaoe bora btt tat ability to 
ioktcd with coa a tc ti vt tinat witboal 
aay irritatioa aad ptradtt bnlJag of 
il M adaptabk k aauiy cattt, todi at lakal 
icplackg boay dcf tdt of tbt aott, ocftclt of tbt 
lower jaw, spUnu for tbt epiae aooordiac to Albcc, 
for cloture of coofcoital deft of tbt ttctnum. 
doMire of chest wall dcfecta, etc L. A. Joaaaa. 

Udorc G. aad Waklit Otitoat Graft Tdtmi fkwa 
dM Hrtpak 10 Wepkct Oraakl Loea; Ivonr 
Pktot la Cfco Repolr of Gnuilal Loeaaa (Purte de 
wihrtancf d« crinr olfliirrfc |Mir oa grrfloa omeas 
■ ■pr u B tl A r omople tt ;deo«olM<nratlooadeprotlikt 
avac dn pkooee dlvobt pour lipaivr dm ptfiat 
de wbaeaiTda Cfiae). BmU. M m4m. Sm, d* €kk. 

df JPtfn 1916, bH, Mil. 

Tbt above nporta wen aabeiittcd by 
Maadain. In Ltderc't caw tbt Ion of craaial 
tabtlaace waa repaind by a cnaiopktty amdt at 
tbt cspeow of a boat aiaft bo r i owed fran tbt 
tcapak. Tbt bok wat tbt tin of a s-tnnc pitot. 
la tbt cttn nportod by Wakb the boln won 
apprasiauMdy 5 caL by 4 cm. aod wen npaind 
by ivory pktta. 

Maadain caHt alttaika 10 ibtdlflMoal amhoda 
of npaifliv fffffit knns ptrkiikt otitoptrktiic, 
aad caiaatoptriottk cnakpktty; (t) autopkitic, 
or bittiaplattir otnoat grafu; (j) 
annratodt 



10 




(O cnaki pnwbttfct; (6) flatly, k 
pwt tbt npak, fat, tertat, aad 



Btcbodi bavt gkta good ittalti, tbt 
b tbt antl antnly cuui kyod aow. 



GENERAL SURGERY — SURGERY OF THE HEAD AND NECK 



107 



but time wfll show whether the cartiUfe 

MencUire review* the history of the varkmt pro* 
cedtnes and thinks that gencfBlly spceking osseo u s 
aad caniUfinous grafu are prslcrablc to prosthetic 
procedures with ivory. laetaDk, or other plates. As 
regards functiooal rcsulu the cad aimed at by the 
soricon b oot the ametiorat ion of encephalic disturb- 
ance, but the protectioo of tiM brain from injury. 
The psychic eflcct b good becaoie the patient feds 
that his brain is protected. The esthetic result b 
equally satisfactory. 

Reporu submitted by Marie, Qaud, and Sicard 
do not, however, show that in cases of repair of 
oestoui breedies that there b any satisfactory 
cerebral functional amcUoratioD. Thus in at cases 
of repair on which Marie has reported there were 6 
ameliorations without complete disappearance of 
subjective disturbance, la absolutely stationarv, 
and 3 cases of aggravation of the subjective disturb* 
anccs. Moreover, Maodaire does not thinlc it 
wise when there b a teadeanr to oerebnU hcmia to 
dose the osieom breech. If there b hypertension 



of the 
repair. 



fiphalnrarhWiin fluid it 



IfBCK 



IS best to defer 
W. A. BasNAN. 



«S7. 



C A.: Roeatgen Ray Treatment of 
tbalmlc Collar. 5#miA. J/. J., 1916, iz. 



The technique empk^red by the author in treat- 
ing cases of exophthalmic goiter by the roentgen ray 
consists of giving 5 points Hampson of ray, filtered 
through I mm. of aluminum over the th>'roid and 
thymus region everv two weeks. The skin b |m>- 
tected from secondary mys by several layers of 
chamob skin. The Coolidge tube is used with its 
anode 8.5 inches from the skin. 

Of 28 cases treated 5 failed to show any real im- 
provement. The other ax showed results which 
compared favorably with those obtained by surgery 
hi similar cases. The changes noted were im- 
pcovonents in pulse, weight, tremor, slecp l essn csa. 
feneral nervousness, strength, and endurance. The 
ewphthalmoa and tumor often persisted. The 
autaor was unable to find any very marked blood 
changes following the treatments; nor could he 
produce any such rhangrs experimentally in rabbits 
even when the treatments were carried to the point 
where the thymus was destroyed. 

The condusions he arrived at are as follows: 

I. That X-raying the thyroid gland alone will 
sometimes relieve the symptoms of Graves' disease. 

a. That the blood count, fluoroscopic, and X-ray 
picture examinations are often midwiding and 
should not have too much effect on p rog n os t i ca ting 
the favorable and unfavorable cases. 

3. That a large percentage of cases of exoph- 
thalmic goiter are associated with enlarged thjrmi, 
which maagr sniteoos, to avoid dangmms post- 
operative qrapcooss and even death, advise resect- 



ing St the same time the thyroid is removed. This 
must greatly prolong and oooqplicate the dificnlt 
operation of t hy roidectomy hi patients who 
have alwajrs been regarded as bad operative risks. 

4. That the roentgen ray will qtUckly and pain- 
lessly atrophy the thsrmus gland, and for this reason 
should be the method of choice in all cases of ex- 
ophthalmic goiter where enlarged thyml are sus- 
pected. AooLm Habtumc. 

Tkeai 



Alklns. W. II. B.: The Etlotegy and Tkentaesit of 
Ktuphthalmlc <;oitrr, «Wl Spodnl Bsfssssue 
CO the Lm of Radium. Csaetf. FrtL 6r JKm., 
1916. xli. 39J. 

Ulicther one accepu the glandular theory or the 
neurogenic theory as the causative factor in exoph- 
thalmic goiter, it b obvious that aO tJierapy must 
be directed at a reduction In the in cre as ed vascular- 
ity of the thyroid gland. The first fssentisf in suc- 
cessful treatment is the most complete bodily and 
mental rest which is obtainable under the drcum- 
stances. Thb alone in the mild cases will occasion- 
ally effect a cure. Other aids, such as proper nu- 
trition, medicaments, glandular and serotnerapy, 
roentgen ray and hydrotherapy, are briefly dis- 
cussed. The author places the greatest reliance on 
the hydrobromate of quinine and ergodn in the 
medicinal treatment of the disease, and dtes case 
histories of seven patients treated and cured by 
radium emanations over the thyroid gland; most ot 
these cases were rderred to him after the usual 
medicinal and other treatments had failed to effect 
improvement. E. Fischel. 



Benjamin, A. E. : Thyroid Diasaee and the Prcacnt 
Method of Opcrattire Treatment. Tr. H'eu. 
Suri. Ass., St. Paul, 1916, Dec 

Of late there has been much study upon the thy- 
roid to determine its true function, the character 
of the toxic substance which is responsible for the 
symptoms present in the diseased state and the 
influence of thb substance upon the various tissues 
of the human body. 

Much data has been secured to formulate some 
definite rule of procedure in the treatment of the 
diseased thyroid. .\11 this study and data up to 
the present time indicate that operative treatment 
u most reliable and gives the noost permanent 
results, also that the symptoms of thyroid disease 
must be recognized by the profession in general, 
eariier, and the gland operated upon, to prevent 
irreparable damage to the heart, liver, and kidney, 
nerves, and musck tissoea of the body. 

Ligation of the blood supply has been performed 
quite extensively in severe cases, in others a low 
coUar incision with a rapid removal of portions of 
the gland, and in less toxic cases dther complete 
removal of the lobes or a resection with the reoaoval 
of the center and the more diseased portion of the 
gland. The resection method with a normal amonnt 
of tissue left in the two lobes allowing the capMile 
of the posterior half of the gland and any healthy 



loS 



IN'TKRWTIOVAt AlISTRArT OF SPRRFRY 



■mnrtuwr MriKiiwv sitaKiivii 



Imi bttn fdwvvd bf 
■■Irifil McktMd A ■ 



u t« nroHun 

TUiplui 
I— In, A tym* 
of MMilaf ii 



Her. 

TIm «itUM>r applU iIm ttna **tttb(oul tkjrroidoc- 
toay ** to Um lywtik^ b Batw l ampuuiioo of 
fioMMtnwjr ■on uyfoU uwm tluui dm Mcn 
caMMBArifaf iHMvad ia tkoMCMM wbcie labicloay 

TW |Mli0Bl« If A womuL mmaam the oprigbt 
poiilhMi. aad p«u 00 a ckAM or a tlHag of biodt 
MintiM wh&n tkm 6mkm to wmt Um mow; 
cImo IM boAtioa b MAilMd OA Um iUa to beau 
ibtiCArvliicktlMsrAiotohidolAtor. TiMpAtioni's 
porfrioA oo iHt opofAtfan tAbIt wboonrM the pur- 

EM of food ospooon ood ittohihlurt blotmat 
tW oppor ood of tW toblo boiat olovAtod ADd 
PAtloM'k boAd tbrava bAck. 

• A flHMBAl ABAHlbctic b IMcd. CtbOT VtpOT k 



blown inio io« ptsanriu tlirv«igii m «••• i 10 

wbkb two aoMl tabti Aft AltACMd. Afur ibo 
wfom polo of Ibt poliOT boA booo UfAtod, ibt lobt 
b bolAiod AA wodi aa poMlbb Aod cbuopod cbiv 

ACVOM tbi bAAt AbOVt tbt pfaUM of tbo faMOBdod 

AapotAiioA. Tbo iwAlihn Vibipod dbct b 
Mtofod witb CAtAot And Iboi mucb Uoodkp Aod 
bbor AT* Avokbd. Tbo Ugating U doM viu iao 
aitfui. wbkb b wbbdrawo m oecdod fraoi A tobv- 
br gU»« locoptAcb, bold fai tbo opoiAtor'o bft baod. 

to thu OMUUMT, WAttiOA AOd tolUag of UfAtAfO 

mairrul MO piovoBtod. Tbo doip d«oct b dfaiood 
br a split nibbor tubo wbicb b bid tffAaovoMljr 
aooM tbo bottom of the brai ddbct and CAffibd 
o«t At the two oodo of tbo tadrioo. Tbo •kin b 
doted with entodbfljr Im tUk 00 to vbidi lioy 
aoo<uttiQg ntoditt bAvo boos tttmpod ImiDo> 
diotdy Aftor tbo optfAtion, tbt pAtioot b put to 
bod 00 bor (aoo, to penult prompt ctcapt of tracbtAl 



it tulhot ttttc* that hb rrtulit In toiic 
have been uniformly ideal only lincc he 
tbb toduique, l o a a o fo d a mfident Aaooat 
goitor tbwio At tbo pdamry opontioo. 



"S 



SURGERY OF THE CHEST 



WALL AND IUt£AST 



Wbbtl 



J. 8.1 

bi 



of il— nofj Tbooo Mb- 
IV. SMrfft. Smt. trCytm. Au., 
1916, Dec 




Hotdij calt AtlOBfbo to tbo foct that primary 
■ri^OAttt tpithdbl giowtbA bi tbe axiOa are rare. 
Tbt grovtba AtOAljr fooad Aio awt attat ic tbrough 
tbo Ijraipbatica. Ho npocu a cati ia ab onmArried 
46 yoAiA of Aft, «bo bod two dttcfB witb 
Tbit pAtitat aotiood a nowtb fai tbo right 
quite pAiafoL Tbere wm no 
ofawprimAfybtSoatbewbofc. A blodi 
iliatcrtkin of ttt axflb was mtdn Aa oauninatioa 
of the ibtot fcowvud tbowod b to bo aioHgaAaf. 
•ad. aftor patbotoffcal oiaadaAtina. Dr. Bloodfood 
nportod tbAt it WM caaotr of tbe amauMty tittue. 
Tbt ■jwplnmt of poia wUdi aio naatuAl ia tariy 
' ly dot to unatait oa tbo lattr- 
u Tbt poia ttmaod to booooM 
boat owy tbret or four wotko. Tbo 
of OAi^ pMa Aad of laaot Aod poia da rbn 

Tbiot yoan aad four amatbo oHor tbt optrttioa, 
tbo polbal WAA Mtmiaod aad fooad to be entirely 
fiotfrom 



A. &t Qacbiiaii of dm Malt BraaM (Gar- 
de b maam to el bambie). fnmm wiii., 
Aivna.. loiA, ■• t am., ti. 

Tbb b Uw ttcaad COM of CAidatoM of Um amk 
bioAtt npoctod bgr Roio Aad BMkM tbt tbbd CAM 
la tbt AigiBtlat lilaniaio. Tbt pAtbat wm a 



nun of 70. Tbt ditette btaan alMmt it yean 
previoot with intente pain b tae nuunamiy icgioa 
wbidi bter showed tumtfactloa, tiporblfy About 
the left nipple. Tbe inflammation di to p p Mi td 
under local treatment and gave no farther troobb 
until three yean ago when acute iaflaouaatocy 
phenomena of the aamt diAfACtor M btion but 
more intense retpptAiod. Euminatioo showed a 
bAfd lobulated nrTr'nm in the left breast. About 
the nipple then wm a VAtt, irregular, baid ulc«a- 
lion with reddiab vegetating pntdiM la wbkb 
ibiaII pofuleat aoaw won aotod. Tbo 
bod lavadAd tbt tobcatAaAoaa otOolar 
part of tbt poctoral mntdt; tbe axillary 
wort modi Augmtattd Abo. 




ILt NoMt on A Gate of GAnbMBM of 

Mtd, J. Ami$Mt^ 1916. ii. m>s 

A CAM of tbot ran con di tion , carriaoma of tbe 
mab bnoat, with reoMval, b npottod. Tbotumor 
WM of two yton' doiAtioa aad bad beta op trA ttd 
apoo A yoM bcfoio. At tbt ttooad opt ra tloa 
tbo poctoral iMda, tbt taptririai ftbtm of tbt 
ptctorolb au^, aad tbt ttmtai OMgaaa, toattbtr 
with a Uyor of fat, wm dbttrttd Away m Tar m 



tbt axillary vda. Tbtra wm 
faada or glaadt oa tbo doip nil 
oaaior. aor of tbo baDi of tbt 



Tbtra WM BO rtaoval of the 

tarfaot of tbt ptctoralb 

Itodf. ~ 



GENERAL SURGERY — SURGERY OF THE CHEST 



109 



k 



than *u nomhs later there were reairrence* in the 
skin adiaceot to the cicatrix and in the glandt of 
tlM axiUa. A third operation was done, at which 
time Um whole of tlie pectoralis major and the 
fibcoUc contents of the aidlla woe removed. 

The rule b that cancer of the male breast must be 
treated just as in the female. The fact that thejr 
are often small should not justify limited removal. 
The first openuion done bv the author in this case 
b the one Mhrocnted by Shield, but in view of the 
recurrence, eeemt not to have been sufficiently 
radical. Cancer of the male breast b often regarded 
•s of relatively low maUmancy, an e r roneo us belief 
in many instiincea. In tne case dted the earlv age 
incidence, 33 years, the local recurrence and ipand- 
dular involvement within ten months all spoik for 
a high grade of malignancy. There seems to be no 
reason to believe that cancer in the male breast b 
in any way difTcrcnt from that in the female breast, 
and the operative procedures should be the same, 
regardless of the desire to avoid impairment of the 
function of the arm. 

Murphy in 1914 advised the radical removal of 
the entire breast, and while Poirier concludes that 
the scirrhous carcinoma most commonly seen in 
the male breast b comparatively inactive, yet from 
the difficulty in dbtinguishing between those of 
varying malignancy at the time when the prospects 
of radical cure are greatest, the teaching of Murphy 
b the only one to follow. E. K. AutsnoHO. 

Leslie. R. .M.: Injuries of the Chest During War. 
.V. }'. a. J., 1916. civ, 6js. 

The subject b discussed from a medical rather 
than a suigical standpoint. As seen in base hos- 
pitab. the great majority of chest injuries are due 
to gunshot or shrapnel wounds: other injuries, such 
as nayonet wounds, or crushing injuries due to 
mine or shell explosions being usually rapidly fatal. 
•re seen oidy at the front. M the rear the propor- 
tion (rf chest cases b from 6 to 8 per cent. They 
sre classed as (i) noo -penetrating and (2) pene- 
trating according to whether or not the missile 
enters the thoracic cavity. 

I. Non-penetrating wounds present no special 
problema. They may or may not be attended with 
shodt according to the extent of injury to the ribs 
or to the veriebral column. The lung may be 
contused by the impact of the ribs sutliciently to 
crate hcmoptysb or hemothorax. The spinal con- 
cuMioo may lead to functional or. more rarely, to 
organic paraplegU, usually following crushing 
injuries. 

3. In penetrating wounds 1 he cfTrcts depend upon 
(i) the direction and site of the bullet track; (3) the 
presence of septic material within the thoiadc 
cavity. 

Longitudinal wounds ~ the patient being wounded 
when lying down — and thoee of the central tone, 
endangering the heart, great vceseb, and brger 
bfondd are much more serious than transverse 
wounds, opedally those of the peripheral sone. 



According to its direction the bullet may penetrate 
the thorax and lodge in some other part or cavity, 
as the arm or ahdomen. 

Shrapnel bullet snd shell fragments are more 
likely to carry septic material from the skin or cloth- 
ing than rifle bullets, licmothomx occurs in 75 
per cent of the penetrating woondt. The source of 
the blood may be chiefly from the chest wall, even 
when the lung b penetrated. The symptoms are 
hcmoptjrtb and d^spncra for the first two or three 
da3rt, then becoming milder with only a slight rise 
in temperature. The signs may be ^vMjfc'fiitg owing 
to emphysematous expansion of the opperlobe of 
the lung. If sepsb b present (pyohcmothorax) the 
constitutional signs are much more pronounced, 
increasing dyspnoea, local pain, and friction sounds. 
Exploration b advisable in all cases not improving 
by the fourth day. Early aspirations may be 
sterile, as the bacteria are at first contained in 
the blood-clots only. Since death from hemorrhage 
does not occur after the third day. removal after 
the fourth day to a base hospital is highly dfsirablt. 
where the facilities for treating complications may 
be had. If aspiration b performed in aseptic cases 
the remote effects of dyspnoea on exertion and 
fixation of the chest wall due to lung colUpse are 
rendered less probable. The mortality as a whole 
b about 10 per cent, due largdy to sepsis. In the 
latter cases the progoosb depends on promptness of 
rib resection and evacuation of septic material. 

In aseptic cases, since the main clot b below snd 
posterior, aspiration should be rather high and far 
forward — sixth or seventh interspace in midaxillary 
line. Replacement with oxygen b successful. 

In cases with a small amount of hemothorax a 
simple serofibrinous picurby may occur, the blood 
acting as an irritant, the signs of which may dis- 
appear in a few days, with Uie exception of a mild 
pyrexb lasting a week or two. Pneumothorax b 
rare, usually on the right side when present. It b 
best detected by X-ray. 

Bullets may cause merely a slit-like wound of the 
lung, other missiles large openings, but the elastic- 
ity of the lung tissue tends to dose the wound and 
bullet track rapidly. Blood infarction around the 
track may be quite extensive. Bullets often drop 
into the cul-de-sac of the duphragm and do not 
reauire removal. 

Injuries of the central tone, involving the heart 
and great vessels, sre usually fatal but cases of 
recovery are reporte<l. ruch as the presence of a 
bullet in the ventricle wall detected bv X-ray. 
(trazing wounds of the heart may give rue to the 
pleuropcricardial friction not infrequently found 
in injuries in the canliac region. Treatment b 
usually expectant. 

Owing to the dome of the duphragm. wounds 
involving both chnt and abdominal cavities are 
not nnoommon. N'omiting and hiccough in an 
injury of the rhrst should make one sus pi ci o us of 
abdominal cumplication. .An occadonal ramh ia 
subphrenic sbsccss. 



f 



no 



rNTKK.NAIUJ.NAL ABSTRACT OF JitKl.KKY 



ltd !• dbpkngnatic iMialA. of w^JUk ilwdltiMdi 

•• uMwrtMit pon 



lo CMM villi MM COlltp 

of iht tfnt— 11 li tW «•• of bnnlrfit MwAii. 



g. Ci TW ilwiMoi of OU GiwIIlM of Iko 
MM, o H9m fMeaiwo. TV. If«l. 5«r|. 4n.« 
d. Hal, ioi4i Dtc 



Beck lUmoiUfOlM A Mv OMllMd of tfwU^ old 
(A«r» of otuowrrillli of Um ribt aad loog booM 
which had pn w l — A r ttadtnoM BBMnr 'trfrr*'*'^ 

•ad dMMHtfOlM tllfW pWMUt MM rOMtBBOO* 

giBn» oad plMofniplM of tht lUfmot ttcpt oflht 

optnilvt pffootdttfft. 
TW OMthod hM iWm ivt objects In vkw: 
I. To dpoM iW dWawid aioo by an adequate 

t. To loW away ovtry vnlift of tW dWaied 
tlHOca oader iW foldaare of t W cyt. 

5. To doat IW wound in MKh a way at not to 
permit a«y dead ^laoe in iW rcaactcd cavity, im* 
pUnt iW ■Iriii'llap 

4- To we oo iotttre material whatever except 
licaium for artcriea, and leave tW woosda widdy 

sTTo l epi o d i ice epithdtum of granuUiing 
•orf am with ilrin ipafta. 

By this nwthod Beck has been able to cure ncariy 
all the cases wUch had p revio us ly undertone 
operatioB and failed and which coold not be cured 
bf inJcctloQ of bismnth paste 00 account of ac- 
qocsm. TWfo is ptactlcally no suture nuieriaJ 
wed in tW ope ra t i on except with rare exceptions. 
Ho deprecates tW proW in trjring to drtermue tW 
depth of bone oavitacs and limiici and, furthermore, 
W daims that fmpt *^ of bone cavities blindly, 
vithoot ocular inwection. Is iinsHfntiltf and leads 
to grave error indfingnosis and treatmenl. 



llstaifWTkont- 

J. Am It 



' with the pemuitctit^y 
of results. tW patieat's worfciuf ability, the condft> 
tloo of the erp o n d e d Uuul and tW amount of coo- 
tnrtioo of iW chert waU. Om hundred and four 
CMSS are wad m a basis for thb study. 
A brief review of tW corrrot literature along these 
ii given, w weO as several pctsonal reports 
mm siiHg anliilal imwrnolhoiBi 
la tW acfiea. t$ cases are to W elimiaated w 
being iaoptrabis. Of tW 70 rsamiahm casss. to 
•re today wwthg aad la good phydcal shape, while 
i were i WwWw si l w amfffcedy impioved ami 37 
are dead. Of tW 10 worUac today. 6 show rhoochi 



A-CiTWUIHawtal 
asoat hyAftttdni 

An , 1916, Isvfl, 116ft. 

TWaatlMr( 



are dead. Of the 10 worldag today. 6 show riwodii 
aad tiW after cma^. 7 ate acgativc aad 6 Wvt aot 
beaa anuaiaed. Of the ij examined for coatiac- 
liea IW ■aximum ws* 1.75 inches and tW adal- 
aMHB, I lack All but J Wvv fuUy rcabeorbed, 7 



Wvo ao iMtaai, • show aagMlvo sputum aad 4 
posllivo. tW avenms dlsplsceawat of tW uwi 
Wat was I iach, all tW ij cases bahig left'sded 
Of tW IS ia ope ti ibia cases, a oalv aie worklag. 16 

Shortle bellevw his rcsulu are dw to tW follow- 
ing factory: (1) awst of tW casss were ssakarium 
casss where mmpleto rmt cstdd W saloicsd; (*) 
Ihay wore of tW mors InlslUpBl adddle dsss. with 
•alBdaai fiuMls to aBoid piopsf living coaditioai^ 
•ad sttftdeat bralw lo lead latelligeat co^ipeta* 
tloa: ft) ikrv were treated ia a favorable year> 
rmin>i (4> they received samU iasuflUtlow 

of gas. ..- - : uvcr 500 coa. aad as a rule sfo to 
3J0 cm., this being the owst important point. 

p \f ritAss. 

TKACBBA AHD LUIfOS 



J.t Priasary Carcii .1 

Mtt., 1916, ic, 45 a. 

A report b given of four cases of primary cardno* 
ma of the lunx. with microphotographs and review 
of the iitersture. In man farriaoma of tW laag 
occun in about o.j of oae per oeat of smepsisi. 
Some four hundred cases nave been pahWehad. 
Cardnoma icums to occur more frequeatly ia tW 
lungi of lower snimab than in man, aooordiag to 
Slye occurrinx in j per rent of the caooeta. A new- 
growth usually starts in a large bronchw at tW root 
of tW luncs and extends peripherally. In tW cases 
reported there were no metastases. In lower snimals 
metastasis outside tW lung is aot c o mm on, Innoas 
of the four cases reported wss there any degree of 
anthracosis. At the periphery of the growth tW 
ceUs may be so undifferentiated as to loae thdr 
canccrow texture. Most of tW caaes are diignosrd 
ss tuberculous even in spite of negative sputiun 
finding! snd are d is cove r so only at autopsy. 

H.G.SI04M. 

HBABT AlfD VASCULAR 8TSTBM 



B.t BoUet Wowad of tW Heart; Pro i e c t M e 
la tfw Aaiwler Veattkalar WaU (PUe du 
coeur par baOe; proiscUle daat la paroi wntii- 
culaire aatMeurr). ML «« mim, Stc dt tkk. it 
Pm., 1916. xffi, 1055. 

In this case tW wouaded ama was broaght to tW 
ambulaacc three houn after Injury, in a dying stote. 
Radioscopy amde iauaediatdy ibowed a ballet ia 
tW left vcatricolar waO of tW heart. TW maa 
died twcaty adautes later. Autopsy showed a vast 
kft hsHaothorax, petforatioa of tW superior loW 
of tW left loM, paa ct lt ona peffbratioa of tW 
pericardhim. whldi waa ca^ty of blood, and finally 
a bullet embedded ia tW aaterior kft ventricalar 
wall. 

The point of faUarest for the author is that tW 



maa should Wve sarvivcd such iaiuries for a space 

satwaitisd this rwoit, 
however, critidacd it. He poiated out that la Wart 



of thrw hoais. RicW wW 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



III 



injorict faiMWidfato or «vcn rapid death occur* only 
in one oat of lix cmi. Iforaover. he thinks that 
if »uch a case were sobmittod to him showing the 

K' ture of a great hemorrhage and harmochorax« 
t with the preacrvatioo of the heart seat, he would 
at once have placed the patient on the operating 
rather than upon the ladioioopic table, because 
hemnitaiii was the moat nrient indication. 

_ _ - W. A. BaamfAN. 

PHARYIfX AND (ESOPHAGUS 



HalL A. J.: Gmo of OMhne Flhresnyoinu of the 
Cleophataa Ganelai Dysphajla and U««tb. 
ArU. RtdUt. A EUttr^Uuraf., igi6, zxi, isa. 

The author gives in minute detail the clinical 
history of a case of new-growth of the cesophagus. 
and also the complete postmortem findings. The 



features of the case, as ilemonn rated by the roent- 
gen ray. were not satirfactorv. owing to the failure 
of complete eiaminatioos. At the time of the first 
eiaminalino, platea were made of the chest only, no 
stndy being made of the ffl s ophagiis by means of the 
opaque mod. The second eiamlnstioo was made 
iHth the screen oolv. and in this way an error waa 
made which would have been obvuted if plates 
had been made. 

The value of the case to the roentgenologist should 
consist of the demonstration of the necessity of 
complete examination, where there is dysphagia, by 
both the screen and plate methods. W^hOc th!e 
exact pathological diagnosis could not have been 
made by the roentgen etaminstino. it would seem 
that diagnosis of an orsophageal comlition could 
have been made earlier in the case if the examination 
had been thorough. W. A. Evans. 



SURGERY OF THE ABDOMEN 



ABDOMIHAL WALL AND PERTTOirEUM 

Babcocfc. W. W.: Correction of the Relaxed Ab- 
^mr'r"' Wall with Reference to the Use of 
Borled SOvsr Chain. Am. J. Obti . N. Y.. 1916, 
Ixxiv, sg6. 

The author outlines the various types of abdom* 
inal relaxation considering the degree of relaxation 
and the symptoms produced. He finds that these 
patients suffer from indigestion, headache, flatulence, 
constipation, and many other symptoms, and often 
aregrcatly handicapped when in the erect position. 

The weakitess of the abdominal wall ntay be 
congenital, or it may be due to overdistention of 
the abdominal wall, as from pregnancy, ovarian 
tumors, or ascites, or to the Reneral relaxation 
associated with wasting and debilitating disease. 
C^esity increases the intra-abdominal tension, 
weakens the supporting walls by fatty infiltration, 
and adds the drag of an increased subcutaneous 
Busa. The weakness may be due to ner\'e injury 
or paralysis, parttculariy where long vertical 
indstons have been made through the anterior 
abdominal wall external to the semilunar line. 

Palliative treatment includes methods that aim 
to develop the weakened musculature, and the use 
of supporting appliances, such as a corset, belt, or 
firing truss witn or without a plate or pad. These 
are not discussed in the present paper. 

Operative treatment for the relaxed abdominal 
wall include one or more of the following general 
principles: 

I. The resection of an elliptical or other shaped 
area of skin to increase the tension upon the under- 
lying structures. 

a. A lipectomy or resection of the subcutaneous 
fat to eliminate this source of weight and tension 
upon the underlying parts, and to better the contour 
of the abdomen. 



3. A reconstruction of the muscular and fascial 
planes of the anterior abdominal wall. 

4. The reinforcement of the abdominal wall by 
the implantation of new tissue or of foreign sub- 
stances, such as silver wire, kangaroo tendon, etc. 

After discussing the relative merits of various 
procedures the author illustrates the various ways 
in which he has used a fine silver chain to support 
the weakened abdominal wall. He believes that 
it has a distinct advantage over the other foreign 
materials which have been used for this purpose 
in the past. C. H. Davis. 

Blad. A.: Studies Reftardina Peritonitis Caused by 
Bile Without Perforation of the Gall- Bladder 
or Bile Paaraitea (Siu<licn urber GaUea-peritofiitis 
ohnc Perforation tirr(>allrnwcKr). Tr. XI Nmrtk. 
Surg. Comg., (toeteboric, 1916. July. 

Peritonitis caused by bile without perforation of 
the biliary passages can be explained by a ferment 
action on the part of the bile and of the gall-bladder 
wall. Pancreatic juice under certain conditions, 
especially after passage of a gall-stone frequently 
found in these conditions, can enter the common 
duct and the gall-bladder rather easily. The 
trypsin here can become activated and digestion 
can take place. Experiments show that if bile is 
put into a dial>'sis tul>c biliary pigments do not pass 
through it. but that if the colloidal bOe b digested 
the pigments are liberated and pass very eaafly 
through the dial>'sis tube. The author obeerved 
the digestion of the gall-bladder wall in 16 dogs. 
H pancreatic juice was injected into the gall-bladder 
or if it was forced in from the duo<icnum and the 
common duct Ugated a peritonitis due to bile 
pigments developed in the successful cases even 
without perforation of the gall-bladder. The gall- 
bladder wall in these cases showed do ihiiifM 
macroscopically. but in the microaoopic picture a 



It; 



INTERNATIONAL ABSTRACT OF SURGERY 



wkk towylitt d«inictiMi tad wftM' 

a«f iIm wan «w MM, w ptol nin g iIm p ii p of 

la Um dlKMrioa, iMouuonsM aiktd whuWr 
iW b B tiu lowd iirfd ImlM abdoMM «aa aoc Um 
iwmIi of a tHMMl kttnM IoIIovIm th« licaUon of 
tW rowiBa 4wl. Mad npM th«i the bOt- 
calottd fokl vat foMd k tiM abdOTMi wkUa a 
it« day*; wkmm a p ai wH iii l kim waa aoi 
tiiMiBl la Otter cam a local pwkoakkdfvilopid 
villi bit dlwdwotWi of all tiM otiaat aroaad 

boi dWrwlM ibtft vat ae ktoiat. 

L. A. Jmons. 

SlBBlov. 1. M.t r ttloy w Uf Vtaml HtnUat 
Sndr •« liM Bomla FoOovli^ m lapf ttt 
atioa. If. T.SLJ. M«d.. i«it. ivi. $ii. 

TW aalkor hat aaalyatdtbt it ta ll t of soolap- 
natd by blmiilf whli wf ttoac t to 
ptiathro htrala. lOi rcoulu. m far m known, 
at foOovt: la tlw $00 caact 14 beraic do> 
Mtdiaa or nctw iacWoot ftvt kn tbaa 
a( of I par cast bt ra hi 

la nfMd to borate la nwdiaa incteoat invoiir- 
he tte Imr aaartcr of tte loctot tbtatb, it must 
te laBMNBbcfoa tbat tte traatvcrMlit faada bdow 
tte miaiantr fold of Dooglat it oohr one half 
tte tbirlrntM of tte faada above Unlcat tbit 
kyor of uaatvoiaalit fatda b united at wdl at 
tte pcritoaevm aotbiac bat the ovrri)ring mutde 
hmmnti tetvtaa aa advaadof hrn^ nc and 
tte aatcfior abeatb which b tte laM line of de- 



At KfBidt tte prtteaoe of iafoction ia tte op- 
oiativt Md, te fdaad tbat tfo doaa catct wort 
floBovod by oahr 3 haiate, while 186 opeiatiou ia 
aa ialocied Md naaltod b 18 berate. In tte 
latter caaet drtiatfi b chiefbr wtpoiitiMii but tte 
beUevet a toMll diala ia tte lectot or mid- 
doct not nuucriaOly infftftt ttedaafv 
if food union b obiaiaed in tte mtwed 
If draintfe provaou inf octioa tad lop- 
pafatfr* thioafh tte MBagth of tte wound it re* 
dacat tte powQity of btfaia in tte ictr. From 
thb it b mined that vai^aal dralnt or Mcondary 
tiab woondt for diainafe are aot ladkated nalett 
tte operator b tan that tte BMfai iadiion ttaadt a 
■Dod chance of firm aatei withoot a diaia at one 
Seofttewoaad. InhbcMtttteberaiatteaMd 
lobear ao nlatloa to aerro Imlm wkh l ata H l at 
foctat paralyik HoaAca 



Ui A 
1914, arii. tij. 



(Sehie «a 

Gee mii, it Cmtmt, 



loaipaiathroly 
ct only socatei 



Htefatva. Barbette fai 1671 tnd Ren a alam de la 
Gamwe to t7s« teve meallo aa d tte pu tti Mllty of 
Inater tenia, bat it wat FMit wte la t7|8 Int 
fivt a conoct dttrrl|Hioa of tte affcrtioci Petit 



tte t**** donal. tte gioat « 
CNil at tte weak polat wte 
Migteooair. Potlt'e doctftet 
Gffvafild demoatmicd that 



drew tttoaiioa to tte aponeurotic triaagit hnwat 

" pe, and tte ttae 
a himbar honia 
doctftet ttood iBI il 
QmMd diioatt rated that there w 
ngWB abtL Le., tte ouadrflataral. to which each a 
honda admit occor. Tte author tbo lepoitt a cttt 
oocarrtofla thb apace. Tte oatitot wat t mta of 
56, wte m Jaauary. 1916, feO from a balght of tbovl 
J aMtera. There were 00 lotiew of toiportaaot 
oacapt a eoatorioo to tte left eoatal ragioa and tte 
maa latoaMd work after a few dtya. A vagne ptia, 
bowovtr, p«nbttd in thr Irft doraolumbar rigloa 
tad tftoaa day* after tte fall te aotlotd that aflor 
t ttrata a hunp appeared to thb raglon, which 
tlthoogh petoltm. yet madt It diflcalt for hfaa to 
BMraat t tttirctte. 

Ftaminttino i it u l t od to a dbganab of lambar 
hcmto and openuioo wat tgreed ta Under cMow 
(orm an inciaion wat made to tte rcgioo of Fttlt't 
trianxic but nothiof wat found. It wtt deddad 
to diaconnect tte fiben of tte great dontl nnitde 
and open up Grynfdd'a quadrileteral. Here a amtU 
reducuile tumor wat foiond. Tte adndnittratioa 
of chloroform wat taoaporarily stopped to order to 
note tte effect of tte patient's moveoHBtt, tad it 
was tten observed that the tumor tiiglimiliiil tad 
bernitted through tte <|uadriUteral. 

Tte bernto wat trei^ as an ordinary hernia. 
Tte breech wat widened after scctiooiag Hoale't 
ligament. Tte tte c o mp ot cd of a tiaatvwao fbar 
wat dimrrted and opened: tte contents of tte aac 
wat a yeUowiih fat tooMwbat of the nature of peri- 
renal fat. Tte sac wat treated by ligation and 
eitirpatioo and tte wound doeed. Tte 
recovered perfectly. W. A. 

OASTRCMimsmiAL TRACT 
'tS.roat A 



of FUaftmoMaGai 



totteFntha 
Caatrttb (BelifM sor 
dar |i1ila|HinBBMia Gesirlt). Tr. XI 
Strtk. Smt. Cmv.. Goctebotg, 1916. July. 

Four catet were reportad. two of which ware 
opctated upon, one cured, ndegmonoyt pttritb 
b dhridad into tte drcumtrribed form and tte dlf- 
fttte form, tad tcoordiag to etiokigy toto prinmry 
and aeoondary fonaa. Tte teooodary form caa 
origtoate from coat to aon t ttrocturet or by 
taab from tooM otter focat. At a 
factor tte chronic h y ptrpl a t tfc gattritb wat praamt 
in each caae. Tte infection #er m wat canttd by 
streptococci. Tte author ooOactad 4 ctaea from tte 
Uteiatare. coodderiag tte traatmeat, tte daration 
(t4 boors to to dayt), tte eymptoaaatology, and 
the dbgoosb of tte¥iiiiii. which to most iattancat 
muM be only t ptobahto dbgnoth, tad thete foar 
tre tte only oott cartd by operation. In one of 
thete cat« a diftee phlagmoB of tte vaatride wat 
fboad tad tte dhgnodt wat aaoaitato. Ia tte 
other three catet drcBBMCilbtd phbgnirma wero 
To tte latter b added a caae of tte aathor't. 



GENEIL\L SURGERY — SURGERY OF THE .\BDOMEN 



««3 



la the tffvM form of tlM iBmsm tremtroent k iMipe- 
Icn ahboagh It b adriMbfe to pcffona a Upoiot- 
onjr to gBchwW otMf p o t Bologiol proccim of 
the abdooMB. The dmnMcribed fonn b cunble 
l»3r dniaoti, or a iimicttai can be performed if the 
pcocf has awimH a ^rook or tubchrook diar- 
actor. 

Bottom recalled a caee of diffnae phlttmoo of 
the dnodwMWuiwcinuiil by Frlefaig and SjoevalL 
At the aatopejr a fiah boae waa fbwMl ia an ulcer 
of the duodoram with Infcctioo by itreptococd. 

L.A.J( 

Davla, B. B.t Pwforatlat Goetric Ulcer. 
5«rf. Asi^ Sc Paul, 1916, Dec 

Only acute perforations are cona i der ed. The 
depends on the very acute pain at the 
_ coadag 00 suddenly and usually at the 
Tenr fm located ia the regioo of the perforation. 
A iiiitory of p r e w i o ua fattric or duodenal symp- 
tooM b oonunoo. The pain b more acute than 
ia perforations of the appendix; moreover perfora> 
tioa of the appendix scarcely ever occurs without 
prriiminary sjrmptoms ia the right iliac 



llelr,B.i The OperacivoTreai 
iooe Uloenof tboteeaa 



Tr.WtM. 



I 

E\-ery hour that dapaea after the perforation 
before operation Icaseaa the chance of the operation 
having a successful outcome. 

Operatiooa are divided into two classes: (i) 
Tkoae done very early before much peritonitis is 
preacat. At thb time the ulcer can be excised or 
turned in with sutures in such a manner as to 
partially obstruct the stomach outlet and a poste- 
rior gastro-«nteroetompr perfo r med. Drainage 
should usually be used m these cases, consisting of 
a large rubber tube inserted throu^ a stab-wound 
above the pubes and passing into the lowest part 
of Douglas cul-d es a c , with or without additional 
drainage of the regkm of the perforation, depending 
oa the extent of toe pathology and the amount of 
leakage. (2) Operations done after the peritonitis 
b fairly well advanced. Here the operation con- 
sists in doing as little as possible except to stop the 
leak and establish drainage. The perforation should 
be sutured in such a manner as to narrow the outlet 
of the ttomach as little as poss ib l e . No gastro- 
enteroston^ should be done at thb time as it b too 
uncertain m its resolta and too dangerous. If 
gastro-enterostomy baa to be done later it will be 
at a time when the patient's vitality has improved 
and he b in a better condition to stand it. Drain- 
age b alwa>'s used in thb dasa of cases both via 
the cul-de-sac and the primary wound. 

Irrigation of the abdominal cavity b stronglv 
t oa d enined in all casca, also wiping out wuh 
spoofta, as it dbaesdaatcs the jnl tn iow aad 
inotcaaea the rapidity of absorptioo of toodaa aad 
of odoo-ocfaaisaM. The peritoneum, if the Fowler 
podtioQ b aaed, cul-de-aac drainage, and proctodjrds 
can take care of the foreiga material in the abdoowa 
much niore safely and more gently than if irrigation 
bused. 




acolMulcipleCbl- 

(Z«r gsnatab mad 

n. ilfjpHt calosasn 

Afdk. f. kUm. dit., I9t6, cvB. 



575- 



It b wen known at the prmat tiaM that the reialt 
of operations for stooaoi ulcer dependa opoa the 
site of the ulcer. CUIrmoot, in von Eise l s be rg 's 
diaic, showed that gastro-enterostomy in casea^of 
ulcer near the ovtorus gave 69 per ceat good remlta; 
in cases where the ulcer waa distant from the pyiorus 
there was only 47 per ceat of good results. Other 
experienced surgeoaa, such as the Mayoa, showed 
gastro-enterostomy for stomach uker to be porpoio* 
Icaa if not dangerous. At the Congress of SnrgeoBS 
in iQu. Perthes explained the cause of this as due 
to the inhibitory actioo of ulcer 00 the rhythmic con- 
tractions of the stomach. In a gaatro-eBtcroatoay 
nude at the deepest point of the stomach the pe- 
ripheral part alone b unburdeaed and alkafixed, but 
not the central stomach section. In taker of the 
small curvature spasm b the cause of the ddajrcd 
recover>' in spite of the good fuactiooiag of the 
gastro-enterostomy; spaamna redocea the effective 
aaion of the gastro-eoteroatomy. 

In diacussing the comparative value of gastro- 
enterostomy ami resection Lick quotes von Haberer. 
who takes a strong radical view: "In ulcer, whatever 
may be its anatomical form, resection b the method 
of choice." \^on Haberer therefore reaecta upon 
prindpk; gastro-enterostomy b reserved only for 
simple dc^rized p]rlorus stenosis. He prefets the 
resection method of Billroth II and does not heritate 
to perform subtotal stomach resection. In one 
case, unfortunately fatal, he even executed total 
resection of the stomach for caOoos ulcer, ffia 
primary mortality in all resections of the stomach 
due to ulcer was 9 per cent. The end-results were 
good. Late examinations of a group of 86 patients 
operated according to the Billroth II method show- 
ed 77 per cent complete reco>'erie8, 1 1 per cent par- 
tial recoveries, las per cent unsatisfactory resnlta. 

The frequency of multiple stomach ulcers htt 
been underestimated. Von Hacker in 1895 drew 
attention to the appearance of plural stenoaes of 
the stomach. Payr recently showed that la hb 
operated cases there were 5 per cent of awhiple 
ulcers. Von Haberer's figure b much higher. Ia 
M3 resection cases he found a6 per cent with multi- 
pk ulcers. Simultaneous duodenal vken are 
mdoded in thb figure. He kat 3 caaea, becaase 
at operation the duodenal uker waa ov eik io ke d. 

lidc's personal experknces regarding reaectioa of 
stomach ulcer are limited. Of 24 operated caaea of 
stomach ulcer there were 4 caaea of resectioe. Of 
theae three were caDona ulcers; the fourth case was 
a tumor-like thickcniag of the pykrk ring. In these 
34 operated cases multipk caUoos ukers were fbuad 
three timca, I a. « percent. It b poaihie other uken 



Ml 
kedf 



owrib o he d, but in all cases the stomach was 
gone over syatenatically. 
The danger of confusing ulcer with cardaooa 



114 



DITBRNATIONAL ABSTRACT OF SUROERY 




nlttiivkf ftra^MML Ply 
tcoBinfer is OT ptt CMi of nMcitd 
KMitatr^ pwwKip b 4M ptr c«L TImm 
IfHW «M Mlwaly chm tvpoM !• fiiML aad 
H fMtctios ftt Um d^^Mil MMlciM w car> 
A. la wihlpli irion. tlww b iMtdiimir oC 
RnOtUt enclMwi or iW Momadl htkk to* 
Ri§y*db^ iIn Avttioa of imniirft 
VKons lanv v ohmu ■ lUMMUig pvionc 
•ad a Mcoad or bmm oa Um AoomcIi body. 
TWi coaibianina b iilativily fiaqooai. TInit 
liikiadiiaiflCMMof voaHabicor'taoibw than 
ic viUiiUt Ncalmiea. 

Uok iMaks itet Um docbbt factor to Um cboka 
btivMa PMOrtioa aad faMfo-oaiaraMoaqr b Um 
daafwofthtoMMUoa TIm OMrulky of rattcUoa 
b tuarfd«Ny>tf»» R>iM to kb ibM t« traa^ 
VMM iwtcUoat loM 98 per ctat. Kucttner in lou 
gIvM for noaotoa a so por caat mort ality . in futro- 
Mlorotloaqr oaljr 4 ptr ccat. Evca racb aa eipo> 
ri«Mod taitMa ao voa Haborer had a mortality of 
■too par cool to raaictioni, aad to gaatro-^ataroato- 
mf loanahai over 5 par oaat. Bat voa Habarer 
tiaatad oafar tbo Itok caoM with gaatro-eotenMtonv. 
Pajrr lata oiad maa tiM tttcratan ap to igio. 40s 
caoaa of alcar moctka wHb a OBoctauty of 10 per 
caat: tba awrtality of gaatto-oatcroatony he fifuirca 
aa 3 to 6 par caat. iitk thtoka the figure (or reeec- 
ttoa appeals atoMiet too tovorabb. The number 
of CMaa (torn the fmat hoipitab are pabUahed pcto- 
dpa^y ahcia aMMton of aarsery work. SmalMr 
ilalblW woald if pablbhaH. he thiaka, ghra a Iom 



H aa alcar 



favorable 

VaaaBy oahr ocrloaa caaea are raeactcd. If oae 
aaeka to fiad imer manr of tiM gaatwHrnierortomy 
paikau later d awl oped carriaoma, oae b lurpriaod 
at the aoMJI aamber. Gremot tivea r.j per ccat, 
Kochcr 1.6 per ocat, Kattacr 1.7 per cent. If it is 
laaBr true that cairinoma devdopa 10 frequently on 
aa ancr a* ita baab, aa (or laetaace, Wilaoo of the 
Mayo Oiaic aaMRa that to iS3 stooiach carriaoma 
ha could prove that the cairiaorea developed upon 
Um baria of aa ulcer to 109 caaea» 71 per cent; the 
advocatca of lailio aniawiloiny adght aay that the 
abova^aeatioaad aaMi Igaioa prove that faatr»- 
ilmieiiiiHj caiM the afcar aad thaa reaMnrea the 
barfa for the devdopmeat of caidaoou. 

The higher awrtality of l aa ict loa b thenfoca 
BOtoff-aal by a higher cardaoma daafer to gaatro- 
eateroatoanr. Moreover« reaectioa doea aoc care 
al caaee of aiaaMKh aloer. The larger ttaibtin 
gf ve aboat 70 pv caat laoovancai to per ceat aMr* 
laHiy, Um VMaaoidar beiag aMialy beltaraMata. 
WMIa thaaa fgarBa.aaoapttog the higher aMrtaBty, 
afaaoai MTH vbhthaj 

fenaa of etaanch aloar aia tiaatad by 

UMa b the caee with paflale tieatod by gaatro- 



eatoroatoaqr. Uek, tharafaia, takiac a adddb 
flaaad batwoaa the advocatea of laeecuoa aad thoae 



«ho(avor^ 

of the atooMch b to 6a laimid If iia *o b 
dbiaat from the pytoraa aad aba if Uhn biha ilight- 
aat aaipklaa of cwelaaaMaai dMn«atk 
la Mtfctari^ alcar of tha pytom If UMva b a 

toaiy b to be aa m l^od. (i) If the 

a hoar alam ataaoMi jii 
battvaaa both iUfmaHi aaca b laiWfttil plaa 
terior 

(4) Mt , 

deaiiad reaolt« farther palliativa 

all the affected itaamch aoctloa aunt be 

W.A. 



caaiea aa boar-glam ataaoab, Mm » aat araatoaty 
battvaaa both iUfmaHi aaca b ladlfttil plaa pca> 
terior aaatriMataroaMaiy oa the pyloric aac 
(4) If theae oparailoaa have aot broagai aboat the 
deaiiad reaolt« farther palliatlva oMUwda are aadaaa 
aad all the affected ataamch aoctloa oMiit be 
rmicted. W. A. B aaw a aa. 



A. 0.1 Tho 
itod Ulcer of c 
PhDa.. 1916. Uiv. 405. 



TraataMM of 



The operative treataMat of perforated aloer of 
ihr stooMch or daodeaam aMMt be detoraiiBad at 
the tioM of operatloa by the geaeral coadhJoa of 
the patieat, ajid by the esteat aad dcgica of tho 
aaw>natid peritooltb. In thoae patleau who coaw 
to the aargeoo late, when any p roc adar a b haa- 
ardooa, oae of the foUowinx metnoda BMHt be fol- 



lowed: (1) doeure of the perforation with adoqaata 
drainage of the peritoneal cavity; (1) whea tab It 
impoeaible, packing and draiaage down to the aiaa 
ot perforation, to which event a aecood operatloa 
becomca imperative aa toon aa the c oadi t ioa of the 
patient permits; and (j) a jcjunoatomy b nuily 
the mctho«l of choice. There b aaothtf groap « 
caaea in which the paticata are seea very aooa after 
the |K>rforation. are to good coadJtion, aad to whom 
the infection is locaJixcd to the apper ri^t qaadraat 
o( the ahdominal cavity In thb group the qaaatioa 
ariaea aa to the advisability of doiac aonMthing 
more thaa BMiely doaiag tbr perforatioa, with an 
idea of effecting a more rapid aad cooiplete cure. 

The aothor givca the reaalta of operative treat- 
ment of 19 caaea. Be doea aot belie\'e that in the 
socood group of caaea the mortality b increaaad by 
gaatro-cnteroatomy, aad advocatea it to eveat taa 
patient's coodltioa will at all warraat it. Tho 
immcdbte mortality to theee caaea, rrgardlaaa of 
operation performed, waa 47 per cent. Ten of tho 
patleau were treated by lauaediate doeure aad 
caatro-aalaiaatooiy with a awrtality of 50 per ccat. 
Of thoaa patleau havtog a perforatioa awre thaa 
48 boon before operatioa, 100 per ceat died. 

la eveat the alcar haa perforated high up 
the canUa to aa laacciMWilB locatioo. or to 



caaea to which the coaditioa of the patieat doea aot 
paradt aa eiteaded aearch for the perforatioa. tho 
tadfcatioa b to oadada aad put to reat tho aatira 
■toawch aad daadenam. aad thb b beat doaa by 
Iflaa oa tomy aad Jefamal faodtog. Thara aia 
eacaptiooal caaea to which local c oad it loaa p iaeaa l 
ocbloa of the deer to whfch a jiJaaoaiMay b 
tadkirtad. EacWaa of the aka^baasli« area to 
tha pwaiaca of aa acau pe rf o r a ti oa b very daa- 
aad b rardy iadinitad 



I 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



IIS 



LmcIm, W.t A Goacrtbutlon to th* Eclolotjr of 
Cmmcm of tbo flmpti^M nd fltnnMirli 
Smt-,Cymm. trO^iL, 1916. udl, 41. 

Thf frnifcw brit fc r umcImb vdm Um SMViphinl 
<HttfibatioQ of caaow* &oA ImvUk tmntit4 4^oao 
CMC* of cancer of the csMpliagM and a (airly liutie 
iBimftfr of cases of faiKTr of ua ttomach, diioiMes 
tba IWMM for the peculiar dituibntioa of the 
bowUm in tboM organ* and cooapaica this disifi« 
Mtioo to that of the cicatri<ti> from swallowed 
corrosive fluids in the sane orfsas. 

This forms the working basb for the author's 
c oaUnt i oo that "the chronic irritatioo from the 
iff il if in of hot fluids b an important predisposing 
canse of fwfHTT of the ctsophagus ana stomach. 

After a hrief discussion of the occurrenoe of can> 
ccr in aninuds and a ronmarison between the cancer 
statistics of Norway and Italy the author concludes: 

I. Cancer of the oesophagtu and stomach to 
peculiarly prevalent among the inhabitants of the 
temperate dimate aone. 

3. The relative frequency with which ctcatricial 
strictures from swallowed corrosive fluids occur in 
the various parts of the oesophagus increases from 
above downward. In other words, the widest parts 
of the cesophagus are the most frequent sites of 
such s' rictures and for physiological reasons. 

$. The distribution of cancer in the oesophagus 
c orrea p oncfs to that of the cicatricial striaures from 
swaBowed corrosive fluids, and in all probability for 
the same ph yti fllflgifsl reasons. 

4. Aiqr part of the oesophagus and stomadi may 
be the starting point of cancer with the escepdoa of 
the pjrloric spmncter which rardy seems to be the 
prinury focus. The organ immediately beyond, 
namely, the duodenum, to practically immune from 
cancer. The reason for the two latter phenomena 
to probably that the ingesta do not leach the pyloric 
sphincter until they are properly modified. 

5. In V cw of the foregoing conclusions it seems 
lopcal to look to the ingesta of dvilixed man for 
the source of chronic irritation, which leads to 
malignant changes of the nrsophagiis 

6. The supposition that swallowed fluids after 
emanating from the cardia are directed along the 
** gastric gullet " to the prepyloric region, to strongly 
snpgo rt ed by the fact that the cicatrices from 

quantities of swallowed corrosive fluids are 



vsaalhr found along thto path. 
7. Sevcnty- 



jr-nine per cent of cancers of the stom- 
ach are also tonad aJong thto path — the cardia, the 
**fastric gullet," and the prcpsrloric region. 

8. As cancer of the stomach follows the "high- 
W^r of the fluids" it seems logical to assume that 
falfESted fluids in particular may be res pon sib le. 

9. Alcohol and other irritating fluids probably 
play a pan, but in the opinion 01 the author "hoc 
fluids," so universally taikcn throu^ioat the tem- 
perate climate aone, in the form of coffee, tea, 
■oops, etc. and ghriag rise to chronic irritation, to 
the main predisporfng canae of nn rtr of the cesopaa- 
gusand su 



10. Cancer of the ffnopha gna occsrs less fr»> 
oucntly in wooaen than in men, because woomb 
drink more slowly and take smaller swallows, wfcidi 
paaa qokkhr throoch, thus saving the ""T^^tg^f, 
whOe the less restotant mucosa of the stomach 
where the fluids come to a stop to moie equally ex- 

11. The fact, therefore, that the ratio of cancer 
of the nrsophagus in men and wooien to 3.5 to 1, 
while cancer of the stomach occurs almost equally 
freqtient in the sexes, poinu strongly to " hot fluids ' 
as the i mp o rt ant predimosing cause. Thto to 
further substantiated by tae reanlu of a compari- 
son between the cancer statistics and the habiu of 
the people in the north and south of Europe, by 
the relative freedom from cancer of the oesophagoa 
and stomach enjoyed by the aborigines ofhot 
climates, and the eztremdy rare occurrenoe of can- 
cer of the oesophagus in animals. 

Priedenwmld. J., and KIcffer. R. P.: Tho Valoo 
of the Ouantilativr Kliminaticm of Dlsaolvad 
Albumin in the (iastric (kintcnts in tho MaH- 
noais of Cancer of the StoauMrb. Am. J. U. 

Sc, 1916, clii. 3}t. 

ViolS and Junghans were the first to report a 
spedal mcth<xl for the estimation of the soluble 
sJbumin in the gastric extract which thqr claim to 
of great value as an aid in the HUgno«u of gastric 
cancer. More recently Smithies has confirmed the 
value of thto test. 

From a careful study of their own cases, together 
with the cases of others, the authors fed jusiined in 
conduding that the Wojff-Jun^hans test to of great 
value as an aid in the diagnosi s of certain forms of 
gastric carrinoma, and when taken in conjunction 
with the other si^ of the disease may be of the 
greatest diagnostic hdp. The test to, however, 
only useful in the diagiKwto of the disease, when 
thm to an absence of free hvdrochloric acid in the 
gastric contents, and then only when the question of 
even traces of blood can be diminaied, and in the 
absence of all retained food residue or of swaOowed 
saliva or sputum. 

The test has its greatest significance in the diag- 
nosto between simple and malignant achvUas. 
Positive reactions are rardy observed in simple 
achylias, while they are freqtient in cancer. 

In fractional analyses in simple achylias the acid 
and protein curves follow each other dosdy. 
while in malignant conditions there to a marked 
divergence between the protdn and add 

Positive reactions occurring under normal 
ditions or in simple achjrlia ^astrica apjpear in dtlu- 
tioos of one-tenth, one-twentieth, ooe^Utieth, while 
when still present in dilutions of one one-hundredth, 
one two-hundredth, and one four-hundredth, then 
to marked evidence of malignancy. 

The test to positive in at least 8j per cent of gastric 
cancers, presenting an absence of free hydrochloric 
acid, aikd in 7 a per cent of early cases. It occofi 
almost as frequently as the abacnce of free hydro- 



Ii6 



INTERNATIONAL ABSTRACT OF Si'RGERY 



cUoik ^dlaiMt diMMt — Iq ptv cm i biwct 

of ffW iQfVOCMMiC Mid to of pif CHft POWlVt 

WoMr-Ji^iMiMrttnM It b aon ftoqMtt Uhui 
ilw pmmm «f lacik add— jimmbi of bctk 
add, ?• p»CMit,j prtdf ^*^£gi'>*"*l*f* f|t 

Sp|S?BmUca?|ff«rfi^ 
mm UM, 8 J ptr OMt 

A poAHv nMctioa moljr oocm te flMdigMBl 
grovuiiiii tiM obdoMOi M( iavolviat tkt itoaMcii; 
iii pMfk view. OHipl la omw Mioriond witli 
noMb aad dtoufcwi; or fai dwoalc fMiritb or 
diMlo ifliylM WybUNlMbof valocManald 
la tJw dtepMrii of fMUk CHdaoau, It b ooljr then 
of d«Hroiro «Im« talna Is oooacctioa with 
ilw otWr dfM of tl» dtaiOM, tad tiMM b OB additloo- 
ol BMOM of oldfaM fai tW dtlft t km of o dbiOM 
fkoQMOiiy Mooi dncwi of aofoodt. 

B.BBitaT. 



pjrfcwl) Tr 
191^ jvljr. 



Xt 



(Utbcr Bidwio 
Hfmik. 5arg. CSMg^ OoMtbOTg. 



TW aotbor f»<tfmrimd aj coMt optntod vpoa 
by K«]r, the pttiod of obi>rvitlon ruglag from 
m^ aoatho to olgto |Omi. In 17 como Wanu' 
nwilod tlw wiliiiwi 01 mrim of f atdo oroaod the 
p ylor M i W M oa^oyod. oaa the Xra^ ciamiiu- 
tM b on caMt ■aoiiiin ooaq>lctc czduston o( the 
pylofviw la 6 cases Rbritr's method was oo ^ doyod 
— partial dirbioa of tW posterior wall of the veatri- 
da aad satare to the aatcrior wall of the ventricle— 
aad failed la two instaacia, dae probably to the 
aataia cKriag way in the arascalarb which was 
oad»tosws, After the awthod of Wilms quite a 
f«« l a caii ta c aa rssalt if Ufatloa with tOk b em- 
ployad bsfoia tlM fssdal sitip. 



orated patisatt had aay 
OashaasynvM 



■Itip. Oalyj of tly op- 
postoperatlve synpCoaM. 
of paaciaatic dissaae; aaother 
whea onadaod by the. X-ray; 
aad la the tUfdpatieat tht o a yt y ii^ of the vcntri- 
da vaa too rapid. 

L uuMiauan ilatcd that he had had oocasloo to 
paDona two aatopdea oa caasa of pyloric oidittioo. 
la oaa oaaa the WBoh* opaiatioa had baea per- 
L Oaa half yaar later tha nrloraa ahowad a 
the thickaaas of a lead peacB. la the other 
laa pyairas was lOMiao ai ay aMaaa 01 oaep 
A fmt aad a half later the pyloras was 
of the prorioBs operation. 
L.A.Jt 



of tha ^rforaa by latnM 
bi tba iaiaili Laasan 

eoa iatialsarioat driU 

a aew aMihod of ow l a dj ffg 
tht pylOT*^ ba aad oa the p ow ar of ptrflaatti ad- 

thttaltUbhtd 




Clovaaai aMkas aa laddoa lavoivl^ aU the Itafm 
id aboat s to 6 cak loaf feOowiaf ut Imnltimitl 
di of tht tract lyiag bttwtta tht utaitdi aad tht 
im ptfttoa of tht daodtaaai; ht taraa to tht 
walb la tach a way that tht larata of the two waUa 
iia bcaaght tOfMhtr to tht iaitstiaal hnaaa. To 
f^^5^ ^f^^^^f iht forsatioa of adheaioas. ht 
an tht BMCoia viiMt at thattoieof the 
aad plaosa a low ititchoi so that a portloa of tht 
atfota aMybt to eoatact with the walb itilppad of 
■aceoa. The saroaa btfoad b satartd over tht 
whoto ottat todadtof tht ai«lea of the 
aad the whob b protaetad by a piece ol 
•ataiad over it. 

Thb pfocsd ar a hat beea carried oat 
BMataDy oa dofi to €oa|aactioa with 
eaterostoaur. After aoawwooka there was ( 
Bood faactioatof of the aew opeaiaf aad there 
UMa raaaoa to believa that the tract of the caaal 




bet weeat he stoyac h aad fnt part of the daodeaaaa 
had baea traasfbnaed iato aa ra^iervioas cord. 

W.A. 




Jaffaraoo, G.t GardiioaMi of 

Duodanum CaiMslly Aaaocto t ad' wid^ 
aebdnt Simple l^car. BHL J. Satg., 1916, hr, 
»og. 

A laiddle-afled oMa was operated upon for sya^^- 
toms of food loleatioa to the suaaach; at openitioa 
a daodaaal alcer, to all appaaraaeaa of the ' 
peptic variety, waad is covorsd; a I 



was perf onaed, aad the patieat nude a aaod r»> 
covery. Three aad a hall years later ha osd, aad 
poat iB ortem esamiaation revealed a carciaoaM of the 
saprapapillary diMMlaaum. extending toto the head 
of the pancreas; obstractioa of the doct of 
with rsteatioe cysts of the paacreas; 
caidaoBu in two or three glaads at the livar I 
c^iaaic Dcdorative peritoaitb of both aaca. The 
stoaui of the fietro-eateroetoaqr auub three aad a 
half years before waa pateat aad aonaaL The 
pyloras was aonaal aad sepamted from the powth 
by r.s cm. of healthy, thoadb dlUtad, daodeaaak 

The aathor b inclined to believe that the patieat 
had a bleat daodeoal ulcer for some tioM aad that 
the fiatr»«ateioetoonr broaght aboi 
rsUtf for two aad a half yaars whaa 

aad daetroyad hb life. The oaeet of 



paacfiatic dbrrhoM — a coptoaa, fatty, pale, ofaa- 
siva otool, **"■»* ^*«***^ oaaihr recocaiaaBit portioaa 
of aadlpB iiid f ood — aaaaka of the otanSt ab> 
aeaoe from the latestiae of lae paacreatic lenaaata 
waa roiafideat with the rapid dadiaa aad lost of 



The bib diif 1 was aot obetractad, the Ub aloaa 
beiag aot oaflKMat to 9^ ^ tecal coioriag which b 
dae to iattractioa bttvftta tht ffcrrliw aad pa^ 
creatic iaioa. There was ao glyooaarb at aay Ubh^ 
althoa^ the paacreatic daa waa iwplnaly ob> 
otfadad, aad it hat htta a coauBoa ohtenratioa that 
tht bhaib of f aaprhans art aaafactad for a gnat 
leagth of thaa. 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



«»7 



Dvodcaal cancer caiact datUi io one <mt ct ev«ry 
j.soo iMMpiUl patienu that come to autopcy. 

Cancer oltlM snail intcMiBeocciinia J.I percent 
of caics upon the baab ol 4.177 inteatinal car- 
dnomata. bat ol tbcae 7S per cent have devdoped 
in the duodenum. 

nfty per cent of all duodenal cancer* are aituated 
in the second part of the duodenum owing to the 
coaspUoUiooi of the duodenal wall in this region by 
the ampnlla of Vater. Fenwick's analjrsis of 51 
cases showed that the first part was infected in 1 1 
cases, the second part in >q, and the third part in 7. 
Geiser's fignres point to the r61e played by the 
ampoHa in augmenting the incidence of cancer in 
the second part of the duodenum for in 71 cases, 51, 
or 71-8 per cent, wers pert-ninpallafy. 

The gastric mucoaa seems to be more snsoeptiUe 
to cancer than the duodenum, for several cases are 
on record where a duodenal ulcer has extended 
throng the pylorus and become malignant in its 
gastric portion onl^. 

The occurrence m some duodenal carcinomata of 
ceUs other than those of the usual cylindrical variety 
has led certain obeervers to believe t ha 1 1 he neoplasm 
coold not have started from the columnar cells of 
the duodenal walL 

The author summarizes as follows: 

1. Carcinoma of the duodenum b a rare disease. 
It is fouiKl in 0.04 per cent of hos{Htal postmortems, 
Le.. deaths from all causes. 

2. Inch for inch the duodenum is more liable to 
cancer than the rest of the small intestine. Of 71 
small-intestine carcinomata, 34, or 48 per cent, 
were in the duodenum. 

3. A causal relationship between simple ulcer and 
cancer is difficult to establish in the case of the 
dnodennm. The author, in recording a case of his 
own, has been able to find in the literature only 30 
cases in which carcinoma seems to have developed 
upon ulcer. Several of these cases are very doubtful. 

C. G. UlYD. 

BosckgrwHak. O.: Eataro-Anaatonioaia to the 
Greater Cunratnre (Enteroanastomose auf der 
Cunrstum major). Tr. XI Ntrtk. St$rg. C^mg., 
Goctcborg, 1916, July. 

The gastrocolic ligament is ligated along the 
greater curvature, and for a distance of 14 cm. is 
separated from the p)rlorus. The ventricle is now 
brought through a rent in the mesocoloa in the 
usual manner and a gastro-enteroatomy b per- 
fonned after opening the ventricle between the 
vessdi in the anterior and posterior wall. The 
author be Uev e s the method offers the following 
advantafss; the opening b in a location where the 
veatxide and dnooenum can easfly be inspected with 
the fBStroacope. It b extremely easy to apply 
dampa and sutures as everything b freely nioiw>le 
and without tension. An inciston here docs not 
injure the longitudinal muscle at all, and the circular 
la^er b divided at the junction of the fibers. The 
jejunum adapts itself to the ventride mnch better 



than in other operationa. Finally, it b theoretically 
aa ndvnntage to make the opening at the beat poa> 
sihie location in the antrum. The only disadvaatafs 
b the fact that the separation of the *%■ — tnt and 
the numerous ligations of vesseb proloi^ the 
ope ra tio n socaewhat. The method has bees 
easployed in 64 cases of gastric and duodenal 
uker. No fatalities occurred from the operation, 
bvt one patient died on the fifteenth day from a 
polasoaary a n i b o lbm and another from a perfora* 
tioa of an overlooked ulcer at the cardia. The 
method has given the author better results than 
those previo us ly employed. All patients have been 
re-examined and all are satisfied with the result 
obtained. In two cases, however, there was for a 
whole month severe regurgitation of bUe into the 
ventride with vomiting. 

In the discussion, Dablcicm asked whether 
after such extensive ligation of vcaseb the nutriti<m 
of the parts did not suffer, to which the author 
replied that the blood supply of the ventride was 
so abundant that no danger exbted. L. A Junnca. 

Long, J. W.: Enteroetomy; a Perfected Technique. 

Tr. Scuik. Smrg. fr Gymet. Att., White Sulphur 
Springs, 1916, Dec. 

Enterostomy should never be done as a matter of 
choice. When indicated it b a life-saving measure 
and has rescued many a patient from an untimdy 
grave. The indications may be roughly grouped aa 
foUows; (i) to relieve temporarily patients suffering 
with intestinal obstruction, as from cardnoma ol the 
colon; (}), to safeguard an operation dcme at the 
same sitting, as resection of the bowd; (3) to over- 
come the evil results of a previous operation, for 
instance, obstruction following abdoagiinal section; 
and (4) to establish an opening through which to 
feed a patient, as a jejunostomy done for inoperable 
conditions of the stomach. An application of 
enterostomy was illustrated by a case of intestinal 
obstruction following abdommal section. Purga- 
tives are not permissible, enemas fail, and the patient 
grows rapidly worse. It b in cases of thb kind that 
enterostomy offers the greatest relid. 

A general amrsthetic b not necessary. Tact on 
the part of the surgeon and a local anrsthftic amply 
suffice. The patient need not be moved from the 
bed. Under the plea of "dressing the wound" 
a few stitches are removed and the edfsa of the ii^ 
dsion gently separated. When the psffitOBenni is 
opened one should not search for the point of ob- 
stniction, w«*i*«* it be easfly reached, Vitt content 
himsslf by dealing with the first disf ended coil of 
intestine that presenu itself. The wnphnsb b 
upon dis tt n itd since it b worse than nseicss to 
puncture the bowd below the obstmctioa. When 
the obstruction b purdy mechanical and no sspab 
b present more freedom b allowable. Without dis- 
turbing the parte unduly a purse-string suture, 
pieferi^lv of chromic gut, b placed into the bowd 
wall. The needle should be introduced rather 
deeply. An area a good half inch in diaoMtcr b 



ii8 



INTERNATIONAL ABSTRACT OF SURGERY 



; iIn wtwt fti two tqaidirtaac 

tlw latitd Midi btiwtM tbt 

cu bt ihiihwrt 10 Mrvt 

of tUoMw tW pons oad 

of tko MM^IO oUoiflMUO. 
MrtOIOli^ 

UMnnocauiMy it 

iIm ImomIoo. Titt cootoiy b pntvoblt to Um katf t 




Wbik thr 



ImM tkojMMfl polai of a 
to dowly Son 1 bob bito 



k b powlbli to do M. tht ommium 
rfMoM bo dimwo aboot tbe tobt and. if need be. 



MlidMd io placo bgr oot or two fine ploia cotfut 
wlofoa. A ifilMdid pfaui b to pooctttrr ib* ooimh 
tool oad POM tiM ditul cod of w lube throuxh ii. 



OlMmioo of Um ooMOtum to Mfrcuanl the io* 
_ boUi bifora and after ibc tubt bos 
i witbidiowo coo oot be too ttioo(ly rmpharfaad. 
bM tbo ptflofotioo baa baao dooe witb tbe 
tbt odfM piopailjr ioifortod, aod tbo parta 
bjr ooMotoflLtlM iatolo oaoaihr oaab 
of itaatf very prao^Nljr. Tbe aatlwr baa bod latoke 
tbol did oot leak a drop eitber bcf ofo or f oUowiof tbt 
iHMval of tbe tobe. Wbfie tbeio b oo operatioo 
■Mfo acnrioaable tbao ao wteioatoaiy wbeo in< 
^featod tbcfo caa be ootUag ommo aaooying tbao 
o fBcal faloU ihjki will not bcoL Tbe tccbnique 
icapa ibc bcoe6ta of tbe ooe aod avoid* in 
of caaea tbe ovfl oflccu of tbe 




I. P.t A New InetninMat for the Appllcn- 
lloo of clM Wen lilt MadUae Stttch In Gmcto- 
loceaclaol Soitary* Tr. Wtat. Smg. Ait., St. 
Paal. 1916. Dec. 

for lafe aod 
Atteoiioo b 
tbroufb*aod> 
tbioogb, rooniog aotoio OMde by tlie ordinary 
•iwiat OMcUoe. WlMfcvcr tbb tvpe of mturr can 
bo oppiiad to ibfiat tiMoca, bleediog b practically 
loipaHBiie. A ipecial otnfed needle oaaoeeo maoe 
witb aa cyv near ibc point aod a iat baadb to wlUcb 
000 cod of tiM catfut b faateoed. Tbe catfot rant 
io a groovo 00 tbe coovox aide of tbe netok aluf t 
tbfoodl tbt eye oear tbe poiot, aod tbe otbcr end 
b tbd to a loof atedlt wbicb lenrea as a "fthuttle." 
Tbo apedal oaedfe b poalMd tbraogb tbe iimucs 
oboot to bo aotoiod ootl tbo eye, witb a loop of 
CBtiot,appeaisootlMoppoaitoMa. Tbe^abotib" 
■aodte cofiyfaif tiM otber eod of tiM catgot b paand 
tbioogb tbe loop aod tbe ipadBl oeedle b witb- 
dnwo. Tbb IbroM Ibe miwtodrbig. "lewinc 
■ocbiot Milcb'* aod b tbe oot ottd for tbe pooe- 
ilor toioio io gtttioiclooottoonr. For tiM aotcrior 



touwo lioe tbt taoM ttitcb b iHido by potrii^ tbe 
■ttdk fioa faaidt tbt Jtlooooi oot tWooiir tbo 
atrata. tbao over to tbt aMtric omuIo wiMcb b 



io fcvcfit oitMr< 
picfcod op by tbe 



Tbo caigot loop b 
00 tbo gaol fir 




oloaa»oadbij 




10 tavt otaily ball tbt tint prtviooiiy oa ylo y od 
io giatrO'Oolorottoaiy. 

tbb OMtbod baa a pUrc in otbtr nugical iolda. 
It boa bt to ap plitd witb tatirfactioo bi bwoi* 
ornMidtctooiyt thyraidtctoaQTf ttCt bot it b oot 
practical for slUn ratuio. 

Draper. J. W.t laceeUaol OtMiruciloo. J.dm.M., 
Au., toi6, Isvil, lelo. 



Tbe catue of deatb bi intestinal obttroctioo b 
Mill unknown, but all footot ttodltt poiot to aber- 
rant activity of tbe doodeoal aod piolMbly pao- 
oeotic crib. Tbe old bypotlMtb tbai tbe todo b 
of bacterial or food demmpo ti t ioo origlo maf bt 
Iffftlttd 00 as discarded. lOelnrdfotioo b of 00 
greater importance in tbb tluui to otbo' **frTnfat 

Tbere b an importaot ratio between tbe toaidty 
of tbe totestinal qiitbdiuni aod its digestive power. 
Tbe tolricatc tyndrome autotosKoda oocornog to 
man wQl be belter understood when we know tbe 
cause of deatb to doodeoally obstructed dogs. 

Bdwau> L 



Starr, C L.t lomseoacsprtf ■ CmW. /. M. 4r 
S., 10 i 6. xl. 133. 

Tbe paper b based npoo 46 cisra, witb ji deaibs 
and 15 recoveriea. Toe tioM of admiiainn varied 
from three boors after tbe ooset of qromtooM to 
eight dajrs. Tbe average time of sdmisiioo of all 
cases of intussusceptioo during tbe past is years 
at tbe Children's Hospital baa beco fifty-sevcoboon. 
Tbe beat time to diagnoec a cose of totasaosoeptioo 
b during the fint tweoty>foar boors. Tbe average 
admissioo time of tbe fatal caso was sevcoty*foor 
hours and the admissioo time of the reoovcmi cttea 



was thirty-two hours after the onset of sjnoptooia. 

In regard to the etiology, to most of tbe cases 
tbere was a history of inicatioal disturbaooe, ritber 
marlicd coostipatioo or diarrbcea, aod it was abo 
a (set that three-fourths of tbe casca occ on ed to 
the »uromer months wbeo ioietlioal iofectiooa are 
most freaueot. 

Io a ddld ooder two years of age tbe ooaet of 
acote paio, vooiiling, coHtpse, ooe or two faocal 
stoob, followed by ttraiofaM| aod tbe pasaagt of 
blood aod onicoa aod poiilDiy a palpobit ti 
are cbaractorittic diagoottic Mgoa of 



Io HiocoHtb tbtfo b always toase Ibcal oootent ; 
beraaa to iotoitaacaptioo 00 bib or bowri cooicat 

after tbt tot oot or two stools. 
Tbt aotbor bafitvta tbat sotisry b tbo 00^ 



Itvta toat soifnry 
treotoMOt oad tbt diagooab b roadtqr oMdt witMo 
moovo. If opti 



tbe tot twenty>foar 

within tbe tot t 



tv-l 
eooipanuivdy eaqr to redoce tbt ioti 
tbb period that tbo 



operatioo b pt^ 
•foor boon it b 



bowel It b after 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



119 



ol tlM Uhmi makes radoctioo 
ilmoM impoMible mnd the only operation in the 
nature oi a iCMCtkm that the autlior advocate* ia 
tbe Kxallcd Joaup'a operation. C. G. Hcyd. 

Bddjr. I. II.: Parforadon In Typhoid Fovars Report 
of a Caaa Aaoodaiad with Acuta Typhoid Ap- 
paadlcltla In a Child Aged Sovao. Surf.. 
Cymtc. brMa., toi6. xxiiL 45 >- 

Tbe frequency ol perforation varies peatly in 
different epidemics. Tbe author's study of the 
literature snows that about 1 2 per cent of the total 
death-rate b due to this complicatioo, and that about 
80 per cent of the perforations are found in the 
lower ileum; so |>er cent of tbe perforations occur 
durinf tbe second and third wedi and the trouble 
b twice as frequent in adults as in children. Jopson 
was able to find only 21 cases under ten years of 
afe prior to igoo. Violent muscular nnovements, 
dtttention, diarrhoea, vomiting, dietetic errors, and 
separation of tbe slough are given as factors ptt- 
diwyaing to perforation. 

The onset b sudden, and b characterised by 
severe pain of rapid progressing intensity, local ten- 
demcsa, chill, vomiting, and collapse; associated 
with a rapid rise in temperature, pulse-rate, blood- 
pressure, and leucocytosts. 

The importance of an immediate diagnoab b 
— ph««i«Ji mid the differential diagnosb of acute 
appendicitis, hjemorrhage, ileus, acute intestinal 
watruction, acute pelvic lesions, and infections of 
tbe gall-bladder are discussed in detail. 

The treatment b surgical. In the choice of in- 
cisions one should not lose sight of the fact that 80 
per cent of the perforations occur in the lower part 
of tbe ileum. The perforation can be closed in 
moat cases by a purse-string suture reinforced by 
Lnnbert or mattress sutures, care being taken not 
to constrict the gut. Free drainage should be 
establbhed. the Fowler position a.uumed, and 
morphine employed until the perilonitb becomes 
well localized. 

The case b reported of a child, age 7, who com- 
plained of headache. Atigust 38; was seen by Dr. 
Nicholson September 9; temperature varied from 
normal to 105". Was seen in consultation by the 
author September 15. September 17 at 7 p. m., 
the patient was seised with a chill, vomiting, and 
severe pain in tbe right side followed by collapse. 
The temperature rose from 102.8* to 10^.6°; pulse 
from 120 to 160 in two hours; leucocytosts 32.000. 

The child was removed to the hospital (or im- 
mediate operation. The appendix was removed, a 
perforation about 16 inches from the ileocecal valve 
doacd, and two additional ulcers that showed clearly 
tbroufh tbe peritoneum reinforced. The child made 
a splendid recovery and was shown at the Chicago 
Medical Society at the time the paper waa presented. 

The author's conclusions are as follows: 

t. While perforation varies greatly in different 
epidemics, about 1 a per cent of tbe total dcalb-rate 
b due to this complicatioo. 



a. Perforation occurs in about j per cent of all 
treated. It b relatively infrequent in cbil- 

dlVD* 

3. Statistics show that over 80 per cent of tbe 
total perforations occur In the loarer ileum. 

4. The location of perforatioo coincides with the 
study of Baer. 

5. The maiority of cases perforate during the 
teoood and third week. 

6. Diarrhcea b an important factor in its pro- 
duction. 

7. Acute abdominal pain during the coarse of 
typhoid should always be taken seriou sl y. 

8. The sudden rise of blood-pfcasore is 
evidence of perforation, while an 
ure b not of negative value. 

9. The importance of a careful study of tbe blood 
cannot be overestimated. 

to. The welfare of the patient depends on tbe 
physidao's ability to differentiate between tbe symp- 
toms of perforation and those of the resulting 
peritonitb. 

II. The treatment of perforation b surgical, and 
the death-rate b in inverse ratio to the length of 
time allowed to elapse before operation. 

I a. Opiates are indicated as soon as perforation 
has taken place and should be continued until the 
peritonitb has become well localized. 

Nix. J. T., Jr.: Rare Case of Intestinal Staais and 
lu Treatment. South. U.J., iqi6, ix. 90S. 

The author reports the case of a woman. 34 yean 
old, who had suffered with symptoms of intestinal 
stasb for more than fifteen years. The transverse 
colon was hopelessly kinked from cjrcum to sigmoid, 
exhibiting the most extreme tjrpe of ptosb. 

At operation adhesions between various surfaces 
of the small bowel and abdominal parietes were 
thoroughly divided, and the raw peritwieal sur- 
faces spMged with a sterilized 3 per cent solution 
of sodium citrate in order to prevent subsequent 
adheuons if possible. The lower end of a Murplnr 
button was inserted in the rectum and held in pos^ 
tion at the beginning of the sigmoid. The ileum, 
at a point near the ileocecal valve, was divided 
between clamps with a Paquelin cautery. The 
cjccal end was closed by a continuous suture and 
inverted with a purse-string stitch, while into the 
upper end was inserted the other half of the Murphy 
button. The halves of tbe button were joined and 
the operation completed. After twelve days the 
button had not paisscd, but with a little traction 
upon the silk tape it was easily removed. Tbe 
patient made an uneventful recovcr>'. 

The advantages of tbe application of the Murphy 
button for short circuiting arc: 

I. Simplicity. The method b shorter by fifteen 
minutes than the suture method. 

a. Tbe most dangerous section of bowd, from 
an infectious standpoint, tbe colon, u not indsed, 
but simphr punctured with a Taquclia cautety, 
thereby eliminating contamination. 



110 



INTHRNATIONAL ABSTRACT OF St'RGKRV 



S. It li u Mrfioridi 
iJm OMcacal valvt. 

4. I( iW bvitoM 
tiair. it CAB bt 
tkt •llacbnl lIuMd. 



from ibt 



vkli •Ughl tfitl te i vpoB 




s^& 




TW bM%n tnoMNt ol Um colon Md rectum arc 
tiM MVury polirm mnltiplt pplyPBili. multiple 
■iImmbmii. um im vIIIoim titawr. aO of which havo 
• c ei» M i otigii Imi tht Imott^ mucou* mtm- 
biUM. Tht ilkloBr of Umm grovtht It HkBOorB, 
tht CMMM odvoMid biii^ Mlliiljr tiMoriClcoL 
CMofeol ■nriMOt JoitiiM tht btilti that ommI of 
IhoM Mt faifiloiy fa ocigto. at tvldtactd Iqr 
thtfatgatnt hittory o f t p>tctq « | diyi Mttfy or 
cwitit UM ny lMft|i]r( ni(itiiMt itBowtaf fuoovu 
of iht IrIUUiv tobttMon 1^ eoloiic favMH. 

That btirfoi groviht OMjr chaift to OM^pMat k 
btgroad dooM, bai why thb oocort caaaoc be 
Mpfafatd. A0 that caa bt ttated poahhrdy b 
that caacar btifat at a taall local pcocttt; that It 
fa tht blood whtraby a dfaipMitb 
bt BMdt; that tht fadlvidoal caaotrctU b the 
of caaotr, aad whattvtr tvtatoally tsplaint 
tht orfafa of caaotr will alto tiplafa tht traatforma- 
tioa oia btafaa fato a maHgMnt growth. 

WUk ilitl%aawt chaafc in a tiiBple pdyp b 
ma, aach fhai^pa do occur (rom repcattd traumata, 
aad both afaffa aad moltiplt polypi or adtnoomta 
thoald bt itmoitJ at tht tatUttt moawL 

dUtr fa no way from aloqilt 
fa form aad alae, thoogfa thnr 
bt dfakal^ BMllpaat oa account of thefr 
t» hiatd. lltat growths tbould also be 
tatlipatad tally. 

Maltfpfa adtaoaMta ooottitule the mott impor- 
taat form of btalgB grawtha of tht Intettiac, the 
btfag thdr Itwltocy to chaage in'o 
ia. Tht titatmcnt b pellUtivt 
Batcfoetomy prevcntj (ccaJ irriu- 
tioa ol tht tUMm but It nratt bt maintafatd for a 
bag tiaw altar tht dbanpttraact of tht growths. 
Ramoval of tiM tumm HMfar or « «M«M b uatatis- 
factory btoMtt of tht fiabttty of 



iniiatfaa ar faftdlaa It may bt I 
faaMtf au^t «f coUtb. 

A portfaa of tht bowti b said to bt coupltttly 
tacfadtd vhaa It b cm off at both tods from tht 
ntt of tht fataMfaal cumI« thoMh rstalalag Its 
normal vatcafar aad ■■ra ■mdiuimma. Tbtro b 
sbwadtni dfakal trhlaact to show that a hm 
aawaat of saottioa coatfaam to bt poarod lata tat 
tadadtd looow Shoald tht coattata of tht tidadtd 
bowti rsmafa tttrifa It wlO bt illtd with macaa 
aad win baooam grsdoally dfattadtd untO dthtr 
lu wall aitras way or a cyst lonaa. The Utter b 
liable to tofcctloa which amy tabttqaeotly petforata 
fato the peritoatal cavity. 

TheJoUowfag Ulostratiirt caam art givta: 



I. 



bach 



growth 

MS of 



of tht 
thtbowal 



Tht fkrtt 
atotodfag coll 
baiag .cioatd aad a 
between the lower Oeom aad the traatvtne coloa. 
The Oeocacal valve proved competeal, aad tha 
cecum buret; thb gave rbe to a iomlistd abtoSHL 
which in turn led to perforatioa of tht tstttaal 



Tht Idtal nocadaia b radical octiipa- 
btat doat by optratlag fa 



ibat Ototig- 

ShoaU tht 

dimppear afttr ta t t w t t o my tht optafag 

Sbt dottd; if thty ptnbc aUtr a prolnaitd 
of IntgatloaBi a p^^ m or total coicctoonr b 

E.K. 





•OtO, 

thafafastfaal tract are pfrforawd 
lot b provided for tht laltatlaal 
Thb 



iliac artery and the deato of the patient 
alter the operation. 

a. The patient was a mao« aged 40, wlw waa 
admitted to the boapital with a dlsanosb of caacar 
of the OBCum. Upoa farthar obsenruloa the 
diagnoab was amplHied to amHgnant crowth of the 
CBCom amodsted with shsrem. The tot operatloa 
was for draiaagB bat at the «m1 of three dsiys thma 
waa ao itspite la the obstroctivt svmptooM aad an 
QaosigBwiaoatoray was performed. The pttbnl 
made an imnsediate r e co v er y and left the hotpltsl. 
Nine weeks later he was readmitted as an ab> 
dominal emergency. Tht patitat stated that after 
leaving the hospital hb condition improved, the 
bowcb acted regtUarly and he was able to return 
to woriL A little pas was discharged from tht 
CBcal fistula but ntver any fbcal matttr. Tte 
opmina gradually becanm sawUar. On tha day of 
sdmbsmn, at 1 1 o'docfc fa tht awralng tht pttltat 
was stiatd with levere abdominal pafa with voadt* 
fag and npon admlttanca to the hospital the ab* 
domea was rigid and very ttndtr. 

At optratioa a awdiaa fadsiaa btlow tht um- 
bflicat waa amda, aad a latfe gaaatity of thfa 
pnraltat amtttr waa foaad fa tht sbdomta, Tht 
anastOBMsb waa perfect. Tha cacal growth was 
hmgBf than at tht previoas oparatioa bat withoat 
sigaa of p a if o ra tioa or sioaniag. Tha bHad tad 
of tht Bwim, how t vs r, waa foaad to ba dtataadid 
to foar ttiMa its normal siae with 

at thoMh tht waO wtro 
with no actaal pcrioratioa. Thb cyallc 
delivered oat of tho abdomJaal wall aad 
Paul* tuba lamrttd. Tht asaa madt a rapid 
and Itft tht hospital at tht tad of two 
muj^ fait sabttqaently dbd of the 
growuL 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



|}| 



The •ttthor't eiplinatkm of the csm it that after 
the short •drcuitiag of the paru the growth gradnally 
iavohwl the ileoarcal valve, caoiiBC complete 
obttrvctioo. to that the esdvded porUoo of the 
ilMm eouki not empty Ua cootepf into the larfe 
bowcL The wtcnukm mllfiftit in the cul-<le-aac 
became infectad from the akeiatiBf growth, the 
Mbtaqoeat evcata beiaf tk* coonterpart of what 
in acute mwrHnfli C. G. Hsvd. 



B.t Sca^jri 



Re—rch— oo Cha Ileo* 



I Ragloa (SliMfio e rkcrcbc MtlU rcKiooe Ueo- 
). Gitf. 4, r. Atttd. 4i mud. 4i r«riiM, 1916, 



Indx. 191. 

Upon the baus of the literature of more than 300 
pubttcatiotts and 00 the careful study of 330 cadav- 
ers betides many caaet ttndied during life the 
aothor critidaet the four morbid s]mdromes in the 
ileociBcal intettinal segment which have been 
formnUted in recent jrcars. These syndromes are 
thote comprised under the names "oecum mobile," 
"membranous pericolitis," **chroak intestinal 
staab" (Lane): and the "I n tu Bci t fy of the 
ilaoarcal valve (Hers). 

With regard to "oecum mobfle" the clinical 
researches and autopsy findings of the author leads 
him to coodude that it is not a distinct disease, as 
it very often occurs with a complete absence of 
dinkal disturbances, and because even in the more 
forms it represents only a panicuUr 
disposition and b in fact only pan of 
an enteroptoais which cannot be considered as a 
disease. 

Regarding Lane's theory of "chronic intestinal 
stasb," the author directs attention to the adher- 
ences about the termination of the ileum, appendix. 
ascmdiny colon, etc.. which Lane connders as 
UjummH au*ss«ri ei acquisiu created by nature 
to prevent the prolapse of certain intestinal seg- 
ments. 

While the author acknowledges that the mate- 
rial on which hit coodutions are arrived at is rather 
limited when compared with the large number of 
Kiijiuh and American observations, yet he believes: 
(i) that although Lane's kink may, owing to the 
obatades created, cause a series of clinical S3rmptoms 
demonstraMe by the X-ray and a complex of anato- 
m opathologic alterations, only by further studies 
can a decisive opinion be arrived at reganUng this 
entity; (3) that the mechanism of production of a 
Lane's kink is not always identical; (j) that it does 
not appear to be demonstrable that there is a 
band of new formation in the sense described by 
Lane. 

Regarding Jackson's membranous pericolitis, 
Quarella pnfers the theory of congenital origin 
of the membrane and thinks that it is the per- 
rittaoce of the right epiploic diverticulum, the colic 
an ^plooo of Hallcr. This was put forward as a 
ann|ile hjrpochesis by Keiller of Galvcttoo and was 
demonstrated by Leveuf in France on a certain 
number of fcetuses. The author's 



cadavers have shown it to be absolutely true in 
all cases which respond to Jacfcaon't odfinal de- 
scription; m oreov er , he has been able br cartful 
dissection to etiablith almott ooottantly taa direct 
continuity of tht moBbimne with the sreat omcotom 
both by m tnafomkal features and by its vatcnlar 

OMpOtltlOBB. 

With regard to the etiological qoettion of the 
in ei iflirinnn r of Bauhin's valve, the author's ttodiet 
hvit led nim to these condnsioos: The valve 
wfaidi is incontinent in the feetnt and in the infant 
till about the end of the first year is perfectly 
continent in the normal adult during the contrac- 
tions of the cecum. But it may become inooo- 
tinent because of (1) anomalies of formatJoo: (a) 
ectasia of cecum; (3) chronic procettet (such at 
perityphlitis); (4) by contracture of the ■•«-»tw«m 
colon and co n s e qu e nt increase of aecal pccature; 

(5) by specific lesions (ulcer, tubercnloM, etc); 

(6) according to Hen by alteration in the mucosa. 
The author finds from his studies that Ovular 

insufficiency b especially concomitant with aecal 
ectasia and the occurrence of chronic proc esses and 
that it b secondary to them; and that contrary to 
Herz's view insufficiency of the valve b not an 
autonomous morbid entitv. 

The author further b of the opinion that "cecum 
mobOe," "membranous pericolitb," "Lane's kink," 
and "valvular insufficiency" are all only variations 
of the same syndrome, which has ••*^*ffH a partic- 
ulsr individuality according as the originators of 
these so-called entities were attracted to particular 
manifestations of the anatomopathologic alterations 
met with. There b one essential factor in all these, 
that b, that all these affectifms only cause trouble 
by one method, retardation in the p r ogre ss of the 
mechanical function of intestinal evacuation. 

The author does not a^ree with the "*«^*»»"Kal 
theor>' that intestinal stasis b a function of restrict- 
ing bands and torsions, because it docs not explain 
all cases. He thinks there are two varieties of 
stasb; Le., functional or dynamic stasb and mechan- 
ical stasis. 

The particular dast of mechanical stasb which 
occurs in the ileocecal segment alone has occupied 
the author's attention and for these he propoaet 
thb classification: 

1. Stasb due to ileal inflexion. 

2. Stasb in the cecum and ascending colon. 

3. Stasb due to obstruction at the levd of the 
left colic angle. 

4. Stasb due to sigmoidal alterations. 

The first two forms are the most important. 
Ileal stasb and stasb of the right colon are distin- 
guished from terminal stasb 1^ the fact that the 
former b accompanied by phenomena of general 
tntojdcatioo which are either wanting or very slight 
in the latter. 

Ileal stasb b, in the opinion of the author, deariy 
depoMlent on Lane's kmk. as has been proved bv 
■iniitfoM ob s e rv ations, but it b otherwise with 
of the right colon. Operative interference 



IK 



DTTBRNATIONAL ABSTRACT OF SUROBRY 



will dMr ip Um caoM of tiMtt, tad dMhraoi 
«a Atom tint tiMy 



May bt dm to thtm 



I. Habitttdli 

>. C«co<alk 

i. M— i hn i M 

4. ruilliMillli 
•ppMitfSf b M li i y PMni 
'S. BHWr pMthv 
fai tW MMOibr tOM «l tl» 




TIm Mffkal tfMtsMal wB JMwd oa what is 
It. Wf, A. 



IbwMl ia tW iadhriifanl 



f. A, Bmukkam. 



Sort . Pyb.. 1916, fadv, jil. 

SutooM ol Um apptiidit it lara, tlierc beint 
reported ia tW Mtiia ■■dical Utcfatarc but ten 
■albeaiic caaci^ TiMvt b jiaat diftcalty at Umcs 
ia dttMaiaiM bittokficalnr whotber or not tbe 
ca a dlliB a of Um appoadit b of a chronk inflam- 
■alory or of a aaopbatic aature. In nuking a 
tfagaoiiii Um aatbor affM Umi Um clinical picture 
bt takaa iato coarfdHatioa. aa well aa tbe micro* 
atopic iadiapb SafOoaMof tbrappeadix,eH»cially 
ibe nmad-cal type, coatrary to the viewpoint held 
hevatoforcbliVdy BMUcnant. There b a cbrooic 
' coaditioa of the ap|irndix. in which a 
Mtoaa aad codoihcUal proUfcratioo 
ibat baa bota fon ai dei ad farrinoma, but the 
biMory of aacb caaea does not bear out this 



Tbt treatment of 
aaaaOy been simple a 



•arcoBM of tbe 



appmdii 
Tbe proci 



baa 
p rogao ib 
b la« bvocable than in cardnoma of tbe appendix, 
Tbt aatbor prcaeaia a tabic with brief histories of 
al caaea reported to date including one of hb own. 

Gatcwooo. 



J. C: Acute 
1916. sn, >$y 



Awu J. Smrg., 



tniBiiin dbcMMi in detail the differentiation of 

appmdicitb from (1) rupture of right tubal 

(>) acute intestinal obstructioo, (j) 

y, of tbe richt lower lobe. (4) gall-bUdder 

afactiom, (5) rigbl-iided renal and tueteral lesioos, 
(A JailaaiaMlnry diecaae of tbe right tube and ovary, 
il) tbe gMtric crisb of tabes, (8) typhoid fever, 
partkalarjy with jatrstinal pctforatioo. (9) tuber- 
caloaa peiiloaitb aad intesunal tuberctuoais, and 
(10) CBcal or appeadioeal caidaoauL 

Tbe aittbor fi^ieves that oparatioa sbould be per- 
fonaad ia all caaea of acate appeadidtb aa tooa aa 
tba dbifMria caa be aMde. If. in aotte leekma ia- 
vohriag tbe rfgbt lower qoadraat, the djagnoab 
be arrived xu with oettaiaty, bt 



it aaifkaUy wise to operatt iiat aad perfect tbe 
dboaoib afterward, lie baa foaad tnat a 



high 

laacocytt coaai* titjom 10 i%jim. baa anally beea 
or aata paaBSottjc oaMa* 

Htdoca aot copioy iodlat witbia tbt ptritooeal 
cavity, oa aocoaat of tbt adbwioai alacb it in- 
F o t amli be waa aocaMOBMd 10 irrigate tba 



abdooMa la casta of 
basdbcaidedUib 

For aa sawalbatic ba 
ttbtr, or aiiroaa oiida 



paritoailla, but be 



occanoaally 
OBtfatioa tJM pa<iifwi b 
Piactodyab b astd 



iniiattd wl 
■jvia aatll aa aaaa baa 
b aMdt to aaload tbt 
Ht rcporu oat dtatb bi 



ia jroai^ cbttdiwi 

WIthia aa boor altar 

ia a alttlac poatara. 

iadJcittd, aad tba 

No food b 

and noatttaipc 

aatil after foar days. 

bb bMt a4o foaaacallfa 

Ataaar E aaaa t aian . 



A.i 



t&«. «Bg. 



— a Rociirf of Fmw 
la I9lf. Am, J. Smeg., i«i6. 



Khrenfritd speaks of the advantages of the end- 
result system eatablished by Codman, when appUod 
to tbe practice of the Individtial sarfsoa. Ht da* 
scribes the modi6cd plan wUcb bt baa adopted, aad 
proceeds to apply it to bb eap trita ct with appea> 
didtis during toe year 191 $. 

Of 71 cases of appendicitis which be operated apoa 
in 191 Si 41 were inale and jo fenude. Tbt yoaaf* 
est was I a and tbe oldest 50. Tbtrs were 8 iaicrval 
or quiescent cases, 18 acute oadraiiMd cases. 19 
acute drained, ij appendii sbscssses or iocalisrd 
peritonitis, and 13 geiMral case peritoaitia. Of tbe 
intcr>'al cases thrco-foortba were ia woesta. Tbe 
proportion of wooMa decreastd aa tbe stvtrity of 
the condition increased, and ieaa than oae-fourth 
of tbe aeiMral peritonitb cases were feiaalea. Three 
flulea died, one acute appeadidtb of aepticcada, 
oat geiMral peritoniiis of septiccada, aad aa- 
other general pent unit is. with advaaoad phtbiib 
and a white count of 71.000. 6 hours after a 
brief operation, probably from shock. Tbere 
waa ocM case of pootopenuive pnnimonia, uddcb 
recovered, and oiM case of encerlMtioa of a pbtlMs. 
Three jrouths with peritonitb developed a toaic 
erythema, oim of which waa diagnoaed aa scarlet 
fever. Otherwise tbere were ao rofapHrali oas. 
Kxr lading these cases, tbe avcraae stay ia tbe hos- 



pital for the entire series was 17 days. 

The anesthetic was ether by tbe drop aMtbod. 
Under ether anesthesia Ehrcnfried be lie vea oae caa 
operate rapidly aad. if the administratioa b aatootb. 
witb a minimum of shock. The skin waa prepared 
00 tbe table, using benxtnc. fuU-strengtb iodiae. 
Harrington's solution, and alcohol, in wqtMaca. 
Tbb preparation leavea a narrow frame of iodaa 
Bwrluag the limits of the operaUve 6cld, wUcb 
prtaarves its natural color. 

Tbt author advocates tbe masdo-tpiittiaf or 
nidiroa iadaioat wlMft ao coatra4adiGatloa tBats. 
lids tccbnIqtM allows of a dfarect aad rapid approach 
without dcstnictioa of atrvt or as a a d t- t btr, aad 
practkaUy witbout bcaMwrbafs. Ia data caaea 
u briap one down onto tbt cacam near tbt btat 
oftbtapptadh '' an abaoess b prsaeat it allows 
of a abort aa<! alnafe tract. wUcb doea aot 

aoil tbt fsatnu pcnioasal cavity. OfteailaMa it 



GENERAL SURGERY — SURGERY OF THE AB[X)MEN 



i^i 



r« extcnuU to the line of adhcrioo of omentum to 
anterior abdominal wall, and aa a result the 
abaceaa can be treated practically at il it were with- 
ool the peritoneal cavity. No walling oil with puie 
b used, eiccpc when the iwMon falb to open direct- 
ly into a diecrete appendiceal abaceaa. 

The wound b euily doted; a running catgut 
ttitch to Deritoneum; a catgut mattrett tuture for 
each mutoe lajwr: trantvertaUt and intcnul obltque, 
and a subcuticular silkworm-gut stitch in the skin. 
The short horiiontai scar in the dank is scarcely 
noticeable. Hernia following thb operation even 
in drained caaet, b practically impottible. one reaton 
bcinf that the nerve supply to the mutdet b not 
damaged. 

For drainage a cigarette wick b placed to the bate 
of the appendix or into the abtcew, if such cxittt. 
Thb b partially removed on the fourth day and 
taken out on the 6fth. If, in the presence of a 
copioot ditcharge, a sinus persists, it is dilated every 
ieoood day with the little finger, and balsam oif 
Peru b poured directly into the wound, the skin 
edfet bang a|»roximated by adhesive straps. 

Ehrenfried ooes not employ the muscle-splitting 
indsion in young children, in flabby pendulous 
abdomens, nor in women in whom there b a question 
of tubal infection, in appendiceal abscess where the 
tumor can be felt near the median line, or in cases 
where exploration is intended. In this seiies it was 
ined 47 timet, against the right rectus 24. 

At for the after-treatment, in clean cases the au- 
thor allows water to be given immediately upon re- 
Quest. Food b omitted for.t wenty-four hours unless 
the patient waa starved before operation, and mor- 
phia is given sparingly when needed. After 
twenty-four hours the patient b given broths, 
malted milk made with water, and orange albumin 
at desired, and a sudt enema b administered. On 
the next day soft tolidt are started. If all goes 
well, the patients sits up in a chair for a half hour 
on the fourth day, and thereafter for increasing 
periods. 

The peritonitb cases have been treated by with- 
holding food and water by mouth for 48 hours, 
maintaining the Fowler position, adminbtering 
to per cent glucose solution per rectum in sufficient 
quamitics, and giving suds or milk and molattct 
cnemata as indicated. Recently the author has 
laed pituitrin to forestall or relieve dbtention, 

g'ving aa many as six or more ampoules in twenty- 
ur hoars, always with apparent benefit. He 
knt Dot refrained, however, in catct of tevere ditten- 
doo, from using the time-honored methods of ttnpes, 
enemata, and gastric lavage in the rare 
when they have been indicated. 



■ndbar-Groaodnhl: Chronic Apprndldtia 

DIacurbnncao of Cascal Functtcm (Ucber chroo- 
bche .\ppeodidtis und roekak Funktiootttoarunntn). 
Tr. Xt Sortk. Smr% Ccng., t^oeteborg. I9t6rjuly. 

In the author's experience (t 70 catct) he hat found 
appcndidtb to be most common in 



of them under jo years of aoe. la ooe-thinl 
of the operated catet tnomaliw of the calon wcrt 
prctent (atony, ptotit, caoni mobile). Appendec- 
tomy produced the bett reanht hi thote catct fai 
which there were chaafst in the appemHx or In 
which a dear hittory of previout attackt waa 
present. If. however, the operation waa performed 
for dytpeptb or ttatb the ramlt waa poor and it 
waa wone in the caaet with attociated anomaliet 
or changes in the colon. Thcae catct, howev er , can 
be cured by prolonged medical or cvtntnally 
turgical treatment. L. A. Jiminu. 

Sbowalter, A. M. : When to Operate In Appandkitit 
Gaaea. I'lrf. i/. Srmi Uomtk , 1916, xxi, 369. 

The time to operate in appendidtb b just at soon 
at a diagnoab nat been made. In thote cases in 
which consent b refuted the author will not attume 
the responsibility and insists that another physician 
be called. Operation b thought to be the safest form 
of treatment even after the second or third day. the 
secret of restUts depending upon what b done in 
the individual case. When infection b limited to the 
appendix there is no more danger in operating the 
fourth day than there U the fint. while if it b not 
limited, the sooner drainage b instituted the better. 
In these cases conservatbm b the keynote. 

The author believes that an exception should be 
made in cases in which the mental attitude of the 
patient and family arc unfavorable, or where the 
patient's physical condition would render the shock 
of the operation extremely dangerous. 

E. K. AxMSTaoMO. 

Lynch. J. M.. and McFarland. W. L.: Colonic 
Infections; Some Rardy Otiaencd Inclmallad 

Types. J. Am. it. Ass . igt6, Ixvii, 943. 

In studying the intestinal canal it should be 
looked on as a unit, the divisions being marked 
by the sphincters into oral, central, and caudal. 
It b the unusual infections of thb last segment 
that the authors are concerned with. Twenty-one 
clinical cases are studied and the literature reviewed. 

It is demonstrable that the rate of progrets of 
intestinal contents b directlv proportionate to theb 
toxicity; i.e.. the greater toe toxidty the greater 
the progress. Hence, the greater the toxicity the 
less the digestive and absorptive power of the 
intestine, thus automatically acting as a protection 
for the organism. 

The conception that the ileocecal valve b a 
mechanical one b erroneous, at ex per imentt show 
it to be a neuromutcular contrivance controllable 
by injectiont of epinephrin. .^gain. the inhibitory 
center located in the terminal ileum no doubt 
plays a considerable rAlc in conttipaiioo. 

FoUowt then the detailed Uttorics of two rases 
of colonic infection, one acute and the or ^ :r. 

In the series. 11 were acute, and 10 t i he 

average age of the former bdng 16. th«i ut tho 
latter J7. The average duraiioo of the acute was 
jt n>ffB!Kf and that of the chronic 70 months. 



I'*4 



INTKRNATIONAL ABSTRACT OF Sl'RGKRY 



In ilw ouioriiy ol cMtt tk&n b t MiddMi ooMt of 

dfatftlMm, Pfffftil. WMM» MMI MMUiliti Of PM( 

villi rapid piln tad Mgli iMipaniait. No 
iptdie onuMi It fowid. Tkt ncul omooy* 
mmsInsm it mdHMlMi. duk rtd, aad frumbr 
with no ddfariio «ietn. Lator, Um * 
i«hc». puctwt of ondiUt apptir, ... 
ok«n imIw Omk aBMonaot. Uodw 




iktit gndanHjr dlM|>ptir ud Um tjrpkol dry, 



of otfopliy uktt plan. 
_ it tlMt of aa acola laflaauaatioa 
of tlia BMMOW taaaibrtai aad iu aobjaoaot attnc- 
toMt. ftoaanHMlfonMofbactariaorpfodoaidut* 
lad fonaaanfowMl oa bactoriolQgical tSHiitatloa 
of Um diKtMipa. la so par caal of tbe icriat the 
apoandii tlwiwd tiaiilar patlwloty. 

A bikf rtviav of iW fitafalttra oa coloak iofcc- 
lioa b givta; oMtt of Uw caiaa, Iwiwrar, baia| of 
lla ^aoic typt, no aiuaipl baiat Bsada to differ- 
catiaie tkcae froai the aoa^padte. 

Of the 1 1 acote caaaa, 9 vara opa ra tad oa. Of 
thaae j are caiadL % aia afaaaat curtd. 7 arc tm- 
paoved* aad oae died. 

Of the g mhacuie caaea, 7 aran operated 00. Of 



thcM 4 are cured, the other 3 baiag maiplk a t ed by 
arhle iaipiovad are likdy 



to 



TW operatioB of darfoa la i ant l oa ty with local 
ccOal traataMOt; aeit. a p p ea d Jc oa l OB i y with irrt- 



The dedoctlooa drawa tnm thk aariea are: 
I. Acute purulent ialactloaa of the coloa caa be 
carod only by puitwf the eatire involved area at 



a. Strikiaf h a p r o vcmmt in the acote caaea b 
aeea after Beoatoeqr. 

3. The old idea that if a ttoou were made in 
the aaiaB lataatiaa the patient would loae ground 
haa baaa provad a fallacy. 

4. A itoeia to be effective nuat be placed oral 
to the farfoctioa. 

$, The iaiactioB naoaUy begiaa aa aa acote pro- 
oaaa aad b oftaa overlooked btcaaaa there b ao 



*. Thoatpaeatal rharafter 

labiaaca dae to a chaafe^ the vaaoaiotor 

aa aa etialatical factor. 
7. No active bacterial afeots have aa yet beea 

P. M. CaABa. 

C of Oanatlpatkip by 

Cloa Of Recarda- 

J. Am. it. 




are pcoab with 
kmiabby 



coloa; recaidatlva aaffalatioa at 
the ipl— ic Anmre; relardalivo aagalatloa at or 



ariih or arlthoat 
of the aigBMid. It b the comc- 
tioo of theae by aafikal waaaa that Read advocataa. 



Tha caatial idea hi aaiglcal tiaataiaat of 
kal aiaab b to laacora aa far aa paaiMa the phyaio- 
loflc draiaaft of tha fauaatUMa. Thb may ba 
accoaalUM hi two vaya: 

I. By ladfcal w taaa w t tadi aa aadaioa of tha 
aw, w aa ctl oa of tha traaaawaa celoa or ifa mn l d . 



aa of tha alfBMid, ftano- 
Road'a aMtSodfaOt hi tha 



t. By eoaaannulva 
of tha BM a wiB i oB , iial 
pMw uid ooMatopainr* 

Uttar daaa aad b kaoira aa tha parietal bnplaan 
tlea of the coloa; tea o^|act bali« to panaaaaatir 
laatora the ptotic coloa aad ttoaaacB to thabaonaai 
poaitioo. 

The important atap io the operatioa b the autur* 
ing of tha ooMotttm to tha tiaaavaraalb faada after 
an indaioa through the appar part of tha ahdnaiaa 
Thb not oahriaaa tha tiaaavorw coloa aad atowMch 
but raiaaa tha aacom aad rtliavaa tha rttardatlaa 
aagwlathma at dthrr the hepatic or ^daalc flaxurea. 
Pravioaaly all iniUmmatory coadhioaa haiw locdved 
apnroprbte treatment. 

Kmphatb b put 00 the point that thb b aMfaly a 
coaacrvati\'e method and b not inteadad to aap- 
plaat any of the more radical meth oda. Heaoe, 
to be aoccaaafttUy oaad, the caaea must be carefoU^ 

The author has used thb aaathod aloae ia aa6 
cases and in 62 others in combiaatioa with aoew 
other procadoia each aa cholccyvtotomy, laaactioaa, 
or anaatamnab, etc, and reporta a gnaa aMntality 
of s per cent with 00 deaths where parietal 
implantation aJone wss oaadl 

Pcrmaornt results var>'ing from nuriicd improve* 
mcnt to functional cures are reported in 250 of 
these cases. P If. CBAsa. 

Martia. W.t Colon Rsssctioo and Ita ladkatloaa. 
MmyUmi M. J., 1916, lix. >J5 

Tharab ao doubt that caacer of tha coloa b aa 
uadiyrtod aaiglcal problem which should ba dealt 
with by w i daa pr aa d laaartloa, tha aooaer the better. 

caae ahould be reported favorably ontU it haa baaa 
kept uader fv wi^»mii Ki> for a fftoaffirfable pt irf od, 
as ita awflla are to be judfad by ultimata raaulta. 
The oparatloa b atrictly of a ai^jor aort, aad ahoaM 
be ^^l yl fTf f^ff^ oaly la obatlaata aad caaggMatad 
caaaa, but before tha devalopBMat of a toasaaa 
that of itaelf viD defeat the good effocu of tho 
operation. It b aa op er a t ioa too haaardooa to ba 
undertaken for the roief of coaatipatfaa aloae, te 
bring better to treat tha hwaliaan obatractloa or 
sharp aagnlatioaa which are piaaeat in so ouay of 
theaa oharfaaita caaaa, rather thaa do a total raaac- 
tloa. The daagera attaadiag the operatioa are 
raaMMa poatopatativa ilaoa aa wall aa 

Whia tha ooloa b a pan of thehuaa 
which caa be ithataMd with, yet in the aMJorfoy 
of caaaa of laatctba a coaridieraMi portioa of the 
coloa b alwaya left, thb beiag aaflkieot to take oa 



GENERAL SIRGERY — SURGERY OF THE ABIX)MEN 



«»5 



Um foBCtioa o( the part renoved. and, this nuin- 
tatoad and fiM drainafe fiatahtidwid, intestiiul 
toicnia ccatcs. 

Datpite the fact that phyriologku point out that 
thint and diarriKra are theontkal daagen of colon 
WMCtion, as a matter of fact they are not observed, 
BO serious physiological deranaemeata occnrriof 
in a series of fifty colon resecuons done by the 
author, five of them complete. The ^ief daaiers 
are the operation prr se and the possible immediate 
and remote obstructions that are liable to follow. 

E. K. Aa MSiaowo . 



Palkenbart: Gardnooia PWsur* .Slgmoidca. 
HtmUUm mtd. Wcknukr., 1916. xlU, 1177. 

Falkcaberg operated upon a patient 66 years 
old for extendc<! carcinoma of the liexura slgnKridea. 
He refers to the technical difTiculties of unilateral 
large intestinal resection with union by drcular 
suture. This rese c tion was based on Schimeden's 
B»ethod, After a liberal mobilisation of the 
Ibmre, Falkenberf made a lar^ anastomosis 
between the afferent and efferent intestinal loops, 
closing the abdomen over this, after executing 
eztiapecitoneal resection of the diffuse cardnoma- 
tooa mass. More than 25 cm. of the large intestine 
was resected. The intestinal ends were closed with 
blind sutures, tamponed and replaced. There was 
an undisturbed recovery. This method is suitable, 
in the author's opinion, for cases in which extensive 
molirflisation of the large intestine is possible; it is 
a unilateral method of resecting the large intestine 
without the danger of extended circular suture union. 

W. A. BirsNAN. 

Campbell. W. F.: Cancer of the Rectum. Med. 
Timua. 1916. xliv, jga. 

In studying cases of rectal cancer the author is 
convinced that cancer in this region shows less 
conformity to the incidence of "old age" than cancer 
occurring in any other region. A diagnosis of lurm- 
orrlioids, eqwciallv at the cancer period of life. 
should bis verified bv sight as well as by touch, the 
early symptoms of cancer of the rectum being 
altogether indefinite and resembling the symptoms 
of hjemorrhoids. 

The hUjiwmU of cancer of the rectum is usually 
nude late, yet it renudns local for a long time and 
much may be done for the patient. A colostomy 
sboold be done in all cases of rectal cancer, while 
the growth should be treated as when occurring in 
other rejpons; namely, by regional and not by local 
extirpation. Heretofore too much emphasb has been 
placed upon the restoration of normal function and 
too little on the eradication of regional lymph nodes. 
Inadequate operations arc followed by a high 
percentage of recurrences. 

The percentage of recurrences in the low operation 
was 68 per cent, in the abdomino-perineal operation 
the percentage was 18 per cent. One should insist 
npon as thorough extirpation as in cancer of the 



breast, and to accomplish this resort must be had 
to the abdominal anns and the abdonrfno-parinani 
operation. E. K. Kvmmama. 

SnyMr. J. F.t Rectal Opanidoas under Local 
Anastheata. .V. Y. M. J., 1916. dv. 644^ 

Saphir advocates more extensive undergraduate 
study of rectal diseases and more frequent rectal 
examination of patients, especially when complain* 
ingof some condition in the rectal region. 

During the first two months after the opening of 
the rectal department in Gouvemeur Ho^tal 
O. P. D., out of the 65 new patients, 50 were op- 
erated upon in the clinic under local anesthesia of 
quinine and urea hydrochloride. Saphir gives the 
histories of 19 operated cases for the following 
conditions: hemorrhoids, skin tags, fistula, fissure, 
polyp, and dermoid, with uniformly good results 
up to two months after operation. In a note he 
states that of 1 76 rectal cases in the rectal O. P. D. 
during the first seven months, 134 were benefited 
by rectal operation under local amesthesia. 

Ca«l R. Stzihkz. 

Hlrachman. L. J.: Etiology o# Vaccine Treatment 
of Pruritus Anl. Procul. 6r Giuirttmtertl., 1916, 

X. 193 

From bacteriological studies made in 25 cases 
diagnosed clinically as pruritus ani. Hirschman 
draws the following conclusions: 

Vaccines, whether autogenous or polyvalent, do 
not accomplish a cure in any considerable portion 
of cases, only four out of the series being improved. 

Streptococci can be isolated from practiaUly 
every case. In the author's series, streptococci 
were found in too per cent of the cases, and the 
streptococcus frcalis was isolated in 88 per cent of 
them. This organism has been described by llorder 
and Andrews as the most common form from the 
point of distribution, the most resistant to un- 
favorable conditions, and the least pathogenic of 
the streptococciu species. It b non-hcmolytic, 
and while it has no action on raffinose and inulin, 
it alwa>'s ferments mannite. Gate wood. 

LIVER, PANCREAS, AKD SPLEEN 

OeMacfcar: Pedunculated Tuoaor of cha Uvar 
(Stidfsdrehtrr I'umor dcr Leber). Dml$ekt mttd. 
Wckmstkr., tQi6, xlU. to86. 

In the case reported bv Oehlecker the patient had 
for years been suffering from stomach and intestinal 
trouble. \ movable tumor in the stomach region 
had been noticeable for four ^eara. .After several 
examinations the case was diagnosed as movable 
kidney on the right side, and P3ronephroaia was 
recommended owing to the presence of pus and some 
albumin in the urine. However, from the clinical 
symptoms Oehlecker diagnosed the kidney-like 
tumor as a tumor in the abdomen with a simul- 
taneously existing cjrstitis. 

On laparotomy a pedunculated twisted tumor of 



It6 



INTKRNATIONAL ABSTRACT OP SURGERY 



tW Hvw 



VM twd . TW ptdidt of iW tiMMr 
« tlw tdfi of tiM Wt Svtr bbt. TW 



•ad tkt f icovtfy WM «imvmm- 
(ttl H l t to l n f lcoB y the gnnrtli waa m Bd«M«a of 
IW livfT. 



Accofdhig 10 TlHili lodi ioommb liave ody vorjr 
niiljr bioo Uiolod mafeolly. OdUtdter tui« 
Umi llw OMllwd of VoJkor Md Udntoberf »U1 
ofloo voiy diifty tkom rtum of potltioo ol the 
UdBcjro. Ihrrtoiiop^y «■• Mi otod In tldi cmo 
iMcooit of tat dMMV of laltciiM a Iwilthy kldaoy. 
INifcuiopliy ikMHl bt NMM to only after all 
oUMr noUfeMi of t*Titi*ftf!Vin haw ftilad. The 



bot lo mort aowo iajfulm, ud pftrtladaily is 
tiMat ca«« lo vMdi tiwpnahn hao ban tW cMof 
■Mhod of traoUMM. tlM laapoM ilMild bt laft 
oadlMwbad uatll tba atvoMb or righih tUy. aad 
tbaa wm o wd alowly. a ttuW aach day. until oo 
ibe tcoib or twrUih day tbcir mnoval m 

MacLaod. N.t Notaa oa tha 

GaO-Bladdar. Ank M^did. tr 
1OIO.S1I, 117. 



of ftm 



9ky for a oollarfol X-ray pkturr ran be 

ilh all (be 



Mlv lor a ooiiarfDi A-ray pi 
oaqr bv oae wbo b faawiar 
c coadwloai of tbc urinary in 



urinary tract. 

W. A. BaaxMAN. 



patbotogic 



9m9» O. J.t Traiiaaatic aafjin^ of tba Uvar. TV. 
Httt Smt An.. Si. Paul. 1916. Dae. 




If adaod Rporta tba lotalgMi iadfaifi la ao < 
The technique included: Spoffc fap 3.$ to 4.5 
incbea; miUt«mtierage aritb onttaory tuba a to j» 
with C'ooliilitr lube 8 to ra; dfalaaca frooi plato 
3,% to 17 inches; line of apoaaro 10 aaooadt to a 
minotaa: poaitioa of patkat, oa bacb; 
with iadatad rubber cuaMoa. Of tbc ao 
aadaad, 17 wen reoorted aa pumniing abaonaai 
•badowa aiiid of the 17 awo operated aad coa- 
firmcd. ()f the Q. 6 had cakaH aad 3 bad d h uadad 
Tbe qucatioa of tba trcataical to ba a a t p loya d in pUbUdden. 0( the odgiaal ao, 10 bad typkal 
tba pwaaaca or aaipactod maaaca of fat|wy (o the biliary colk aad 9 of tbcaa famhbad poritlva radlo- 
ihrer b aaa—rad adwa taa dlagaoria la aiade— grapbic if8olta,aitboperatlyeooainMtloala6, tba 

other 1 not bdng operated apoa. Varloaa adaor 
ataUatio are giyao, bot tba raamtlal faa b that a 
vttfy higb pfwaatagr of poiitiva roaalMaognipalc 
fiatfiaf* waa obtained in the caaca of ca elac yat itb, 
aritb aad without ftoaca. AtaBBt Mittaa. 



lapaiolooiy b iadicaicd in every caae of probable 
mplafo of the Uvar becaute of tba Imwdafat daagrr 
froai bnaorfbafa. Opantloaa apoa tba injured 
Hvtr aMHl ba paiforiatid with aO tha apeed com- 
patible with aBBllaaaaB aad a thoroagh eiaminatton 
of the a bdnnii aa l viKcra. In an appaWag number 
of caaaa aa injury to the liver b "aacccaafully** 
lapakod oa|y to mvc tbc patieat go oa to autopay 
iaataad of locovwy* arith the eaibartaawag dboovery 
that lajorim to other viaocra or other Injuriea to 
the ttvcr had beea onrloohtd. 

Taaiporaffy ooatral of haiaoribagi' can usually be 
obtalaed by taayo aia g i Suture of the wound. 
llgBiioa of the laisv vaaaab, aad tamponing are 
the aMM aenricable dtiahlani piocedarea. Suture 
aay be e oHd o i e d la caeca where there b little or 
ao loM of aahaiaarr. aad the woaad b cleaa<ut. 
It may be p iecide d Iqr the Ugatioa of biger vcaKb, 
aad la away CMea arait be aapplcawatad by taan 
poatag. LMitfoaof the laifier ^ wada b to be 
oawlayad wherever there b troablaaoaM hwrn* 
orraoaa from aooaHlble woaada. The woaada aiay 
tbea be teiapaaad. cither directly or ladiractly. or 
aataaed. Taa i po ai ag b tha awlhod Maplnyiid in 
the laijial aaaibar of caaaa; It ofada uaiperanr 

It coatrob hMaanhafi faoM woaada which arc 
codd ba laachad oahr by 
ItbthahaHtlaiacnaiaMi- 
I aad hL thaiefora, tho awtbod of choice 
wfeaio the noilaai la la a poacaiioaa coaditloa; It 
b a valaabla adjavaat to aaiare of a woaad wiww 

BSflBBBlflBB IP BO% MNWO* ^v IOC DQMDlv DWBSNO 

of other Ivcr Injorlea caaaot be oartaded. aad la 

cirery caia where the rfapla Igatloa of 

baaa eanbyed^ it b aHoatlai where the 

of iflfacdaa caaaot Uoadaded. Whrrr the 

haa baaa aataiod or b vary anall the t 

mmf ba iHMoad at a roayaratlvdy early period. 



A.t 



bdv, 419. 



of tba GoB-I 
Amm. Smrg., Phfla., 



1916. 



aawarraaled 



Anomaliea of the hepatic recioa follow the role 
of anomaliea e la ew h e r e in that tbey are apt to occur 
in connection with other mallormatJont, In review- 
ing the iiteraiurc. the author area able to &od 76 
anomaliea of which 14. or 18 per cent, arere multiple. 
Tbc uae of tbc ** button-hole iadaioo** b ooademncd 
aa being retponrible for inromplctc aurgery, aa well 
aa being a cause for tbc overlooking of many 
intereatiag congenital defonaitiaa. 

Tbcie have beea five caaaa of double gaO-bladdar 
reported. Each bladder had ba own cyatic dact 
Tnerc b recorded oae caae of bilobcd pJl-bladdar. 
In a diverticulum of the gall-bladder, there b oae 
large cavity and a naaller leoa 
arltb it. It b very dificnit to atau whether 
aa aaoauUyb rnaiiiBilil or dac to aa ' ' 
proctii. Theie haa beea ao caae of hoar-gbMa 
gall-bladder di a co verad, caccpt a« the rcault of a 
pathoiogk procoM occaniagia adult life 

ffl iliwr iatrahapatic guMdaddan have beea 
fbaad. They any ba cea n i a ad with a left-aided or 
gaO-bbddar. AccordiM to Dhri, thb 
b anat coaunoa fai faaaau aad lepdka. 
A left-aided fdMdaddar occapi« a poritioa to tha 
kft of the faldfona IbaaiCBt. aad 1 j caaaa of Ihb 
type ate oa locord. Sach a gall-bladder ai^ bt 
eallnly ovirloohod at ope ratJ oa, or coaf aaad whh 
a coagraltal abwarg la traaepoaitloa of vitcrra, 
the liver aot oaly b raveraad. bat the baait, duod- 
eaum. aad atooMch aa waO. Of thb aaoaaaly. tt 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



i»7 



U9 iworara. ^MVB ut ttcotot of 7 cam 01 
ol the fdl-bladdcr. two oi mkkh wtn 
rowpl i f i t ci d hy ibtf Tw^ ^ tttg ifUKlrug lobg, Tkb, 
ol cottiw. does not include tbe caaet of abmace due 
to dcttroctioa through poihotofic procwKii Ab- 
MBce of the gall-bUdder b not un c o mm oii in the 
elephant, cand. goat, and deer, and in tome specka 
offiah and birda. 

A floating galKbladder has a distinct mesentery 
and b ueoaUy attended by a vide nu^ of mobility. 
Eight cases of this type are recorded. 

GffMiC. W. W.: Rupture of the GaU-BlMSd«-. 
5iirr..GjnMC trO^.. 1916. zsiii. 41 J. 

The author reports two cases of non-traumatic 
rapture of the gall-bladder; one. an empyema ten 
years after a primary operation for gaU-stooea. At 
the second operation a single smooth stone was 
rem o v ed from the dilated cystic duct. There was 
no obstruction and no jaundice. The patient's 
general health was good until six UKmths before the 
rupture. Dyspeptic tjrmptoms and recent tender- 
ness over the gall-bladder were the only indications 
of trouble. Had cholecystectomy instead of drain- 
age been done at the primar>' operation, more 
trouble and danger would havr been experienced in 
the subeequent history and operation. 

The second case was that of a woman of seventy- 
two srcars, with well-defined and conclusive hisior>' 
of gall-stone. The diagnosb was perforation and 
general septic peritonitis from rupture. Operation 
was refused. Postmortem showed a contracted 
gall-bladder around a single large stone with a 
soudl gaagrenooa area through which the rupture 
had occurred and a pint of bile had escaped into the 
ri^ht kidney foaaa. The specimen of gall-bladder 
with liver tiaaoe shows the gall-bladder stone, and 
the reverse side shows a lighter colored stone in the 
liver substance— probably a branch of the hepatic 
duct. .\ timely operation would have saved her 
life, but would not have revealed the second stone — 
no matter whether the operation was a cholccytt- 
oatoo^ or a cholecystectomy. The latter opera- 
tioo b indicated only in small and gangrenous 
bladders. 

Hendon, G. A.: Cholccyatitls With and Wiihoui 
Gall-Scoaea and aCJaaafftcaikmof .Symptoms. 
Tr. S^mtk. Smrt. fr Gyntc. An . White .Sulphur 
Springs, 1916, Dec 

Thb article b based upon an analysb of jo 
personal cases and deab with the factors of age. sex. 
dbability. and the symptoms of "stomach trouble." 
"jaundice colic." "acute indigestion." etc. Certain 
cues are reported in detail which appear to illus- 
trate the different phases referred to in the text, 
two of which are without previous history of gall- 
stones. Two other cases illustrate tbe effect of 
gall-stooe disease of long duration. In one case 
sjmptoim of gastric ulcer seemed to predominate, 
in one apoplexy of the nil-bladder had occurred, 
and in another the gall-bladder had ruptured. 



Boroilua, J.: Early Opendea la Acute Clielecja 
Cicia (Fnwoprraiioo bd akutar C h ols cynUi i). 
Tr. XI Xtrtk. Smrg. Cm|.. Goccabofg. 1916. Jidy. 

During the acate stage of cholecystltb Bordiua 
formerly operated only in the p re een c e of urgent 
symptoms, in the ma|orit^ of cases he advbed 
operation only after cessation of the acute stage. 
Snoe the beginning of the year, however, he 
decided in favor of the early operation and aaed 
accordingly. Borelitts has treated over 600 casca 
of gall-stooea at the surgical clinic of Lund bet w eea 
i8g8 and 1916 and has performed sji operBtioea 

ia6caanof 



on the bile passages. During this time 
acute cholecystitb entered the clinic, including 
(1) }i operated upon during the acute stage; (a) 
50 operated upon during the subacute stage; (3) 
55 not operated upon. 

Of the 21 cases of Group 1 the gall-bladder was 
perforated, and in several other cases it was gan- 
grenous without any macroecopic evidence of 
perforation. In 12 caaea cholccjrstectoenr was 
fierformed ; in 3 others cholecystectooiy, chofedocb- 
otomy. and hepaticus drainage; in 3 caaea cholecya- 
toatomy; and in 3 other cases laparotomy and 
drainage of the peritoneal abscess. Of the 5 fatal 
caaes one should have been operated upon 2 days 
and another 6 da>'s eariier according to toe principle 
of the eariy operation, and would then have had a 
belter chance for recovery. 

Of the 50 cases of Group 2. cholecystectomy was 
performed in all of them. The cause of death in 
2 cases was pulmonary embolism and in i cardiac 
failure. Of the 55 cases not operated upon in Group 
3. one died of cardiac disease. In 2 cases the opera- 
tion was contra-indicated on account of old age; 
in 16 on account of cardiac weaknesa. adiposity, 
asthma, ncphritb. leukemia, etc. In 7S cases 
the patient refused operation after the acute 
symptoms abated; in 13 cases no reason was given and 
probably the same reasoa existed. The author b 
of the opinion that it b desirable to p er f orm radical 
operations upon as many of these cases as possible, 
and since patients will decide in favor of operation 
during the acute stage much more readUy. and 
since the o|)cration during the acute stage b not 
more serious than during the chronic stage if the 
surgeon has had sufficient experience, he has. 
therefore, adopted the eariy operation as a routine 
in these cases. 

In the discussion Bebc stated that while it b 
advisable to operate eariy in all cases of acute 
cholecvstitb (per>'cholecystitis, peritonitb). it b 
difficult and fre(|uently impossible to make the 
diagnoeb He has l>een considering what the 
findings should be at the early operation for acute 
cholec>'stitb. Aside from the piirdy typical cases 
there b frequently found a case co r r e sp onding to 

and at ( 



the qrmptoois of acute cholecystitb 
tion no signs of it are present, but severe patho- 
logical changes (combined with infection) havi^f 
in common that the function of the gaO-bladder 
b perverted. It b uncertain whether U should be 



tan 



INTBRNATIONAL ABSTRACT OF St'RCKKY 




cdM Iqrdrppt. tUMit, or inwuliliit iMhr. TW 
MMlnr pmmd tht um cMiqmaM. TUimmI 
tUi aloM pndkpoMt lo mom fonMtioo. At iht 
optniifaa ■• «H M 01 iW Miopqr thtn b fowid 
fai tkMt €amt • diMooUoo of Uh fw m m ii bfl^ 
Ami aad of tiM iMMtk dKt, ■• vrfl •• of iIm Mttirt 
Mbiy qrMon. tSr dkiMrio b diAnte b«t it 
cuiboptffftctod. Wkot btceoanlUMd bjroptn- 
tloa? TW ttoiM CM U wofod bt tdioi ifcoold 
bodoMtoftMovotlHciMlicyMOM? A 
or a lotolo botwoM tko 
doct ariglit bo fndUob 6«t at th« prrtrnt iIom, 
o d wlicyilo ct o ni b p«Im|I1 ibe better proccdofo. 
lo t nnw. bovovor, tho •ptokor bad a wc ur rc o ce 
vitb fltoon la tbo b^otlc doct. 

Paot ithcMiiil tbo aatoibl of BuU. Patienu 
opontod dofteg tbo qubtcim ttafe aftor acute 
^^ft^f^ locovMod qoiady (cbobcynoclooty per* 
fonMdMM nwoHMMdy ). la anrto cb ob cy i t itb 

Rovmo critkbod tbo or p rwihwi "oaitv opiia- 
iIm fai onto cb ob cyitU b** ■• we are daanc witb 
tbo ten tevovi itaft of a kiog drawn o«t iftum, 
Tbo nooM tbat to wauj aio cstirpatlof tbo gall* 
Uoddw b baaod m tbe onoooo M tbeory tbat 
are forid la or art tbe renilt of ao 
gdl'^ladder. Tbe speaker bas proved. 
, tbat tbe fdlbUdder b iterfle in over 
of tbe caeeo and U infection b preeent with 
k b teooodary. If cvMosUMoy b per- 
umI tt b u a o ur ric a l to 
tbo Ml-bloddar aad ihot bi tbo hfethm 
If tbe bfb bMoclid diaiMii OMtt bo Jnniluioil 
tbo laet few yoart bat only rtrdy 
■toonr and lanljr drained and 
IL He dtod coitt with ulcer 
with crdeou 
tbo' b BM i (occotionally 
fcioiM) and ««» tTTM*m nuaoatilb vbfcl 
anod after tbe looMyval oftbe ftB-bladdor. 
odafcted tbat cholecytloctoay b moot t«ioM 
BoBSUtia, is ftply to Bcrf ttatod tbat tbe 

bim all tbowod teveie peritonltlc 
tbat tbe gtll-bladder in noet caaet 
and la taasy caaet wm prorated. 
la reply to Romdag be otatod that the cbolocyfloo> 
tonr la acsu cb cloc y t t itb retoltcd in heallag macb 
qpoor aad omio MBo|y and tbat tbe operttioo 
wllbtattdeat tocbaioMwat aot nore terkmt tbaa 
ibo drainage. la «*tdH*t coiet of Thifftngitb Bor- 
oiM doot aot Ugtte tbe qrttfc doctaadpca up 
tba hdtcilM bat drafaw tbo bopatfc doct. 

Rovmo aMhuaiaod tbat ITdnteage b properly 
porf owMd witb • tube faMitod into the pIMdadder 
aad tbe latter dropped faMo the abdooMO iocar> 
do aoc oocar. Recarvtaott art frmneat, 
of tbt gaB-Wodder (Roat). 
a foactioo to pe^ 




Itb 




la 
f< 



IdMM tbe gaB-Maddar 

f iTiit ■ iiiMiif 



wftboal tbo 



•latadtbattf 

[bo proatMt 

aa inlcctlon bavlag boM 



Bovmo inaoMd 
faitbo 

la 
aot foOoir brfictita b 
of 



tbat 



do 
do 



witb 
tbat tt< 
A proof tbat 
bi tbo fact tbat 
■MioMd by tbo aatbor 
aftor a low yoan did aot bad to atOM ronnatlM 
aad M tacb caaat art iioordod b tbe literatara. 
BOMMBBvurB agreed eoBMltlaly witb tbo viewa 
of RtfvriBg, aad tbiakt b b oaly a toatporaiy fad la 
aaigafy daaMwUim cstlrpatiM of tbo 
Bo woald BMcb ratbor paifor 
OMt, twico, ortbrta tbaaa witb local I 
rtBMvo tbe gtO-bladdor. Ho baa fooad typical 
rtcanrias attacfca after cbolocyatoctoaqr aad fooad 
abtolately aotbtag at a tecood oporatiM. 

Buio ttaicd that the r ec ur rtn co a could be dM 
to a diUiatioo of the bile peittut witb later ttoae 
formation. L. A. Jobmbb. 

^ ^^ te clM Ugbc of lia 

(Db fItMwMdetitatbtii im Ikblo der 

AafaBopcradoa). Ank. f. tUm. OUr.. 1916, cvH. 

J79. 

Sprengd comparet tbe ootet of c b oloc ynltb 
witb appendidtb aad triea to tinpUfy tba BMdMd 
picture of cbolocyititia. Rogardug tbo origla of 
aallfttone attacka Riodd bM traced tbb back to tbo 
irriution due to tbe calculi wbicb caaatt local 
inflammation and tranaodatioo. Ho tbfadta tbat 
the origin of gall-etOM coUc Ilea eidniivt|y in tbe 
auddcn and lattiaa occbwlon aad tbe rnntoqiHiiiitI 
retention of gall-tJadder contents, which, in accord- 
aace with the \irulcncc of the bacilli present, leads 
to greater or lett deatruction of the ^Ibladdcr. 
Thb opialoo b at vaiiaace with thai of Kchr and 
otber writera wbo consider tbe occlusion aa mo- 
cbaaical and a caaoal factor oaty and wbo, 
aaortov er , regard tbe duonic and acute indaauaa- 
tonr procesaet as independent. 

IWMgil ooQsiden tbe gall-bUdder cbai^ea as 
dbUbb lato groopa: galTbladder rhsMw witb 
acute attack: cbolocyatitb daatmctiva, wbart tbo 
calculus b not reowvabb aad tbe gall-bladder coa- 
tMU are virulent; dadocyatitb timplos, wbere tbo 
calcului is loose and tbe gall-bladder matOBtt aoa- 
viiulent, tbb b tbe atnal typical gall-otOM coUc: 
hydrops of tbe galMdadder, wbicb b a pan 



doaure witb aoo-viruleat contenta. In 
of tbe gall-bladder witb cbroak illncaa bo 
em p ye m a in wUcb tbe oc du sioa b 
In anotber aroup bo plaota all rttidaot of 
rooditions which have passed into tbo qdht 

in which nparatonr iiiiiiiiailBit art 

It, tacb as scar f omatioa, "''•'"^fgr- etc 

W.A." 







talelgi voa Gal- 



of iaiwilffa tbo fa rt 



Riodd taya tbat botb operative prooedorsa aad 
autopsies bave deasoaatratod tevoral ways la wbicb 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



«»9 



^iSLSu^iasz 



pitt or ftll may accumulate above the liver as a 
coaMqMBOt of jdj rtof. The priadiMU ways b 
wUdi tUi Biiipt occw arc: 

I. By the lormatioa of abaoaiMa vadcr the liver 
dome in coonectioQ with a ffcohoghia punilrnta 
dae to itooM in the ductoa ch otodo c n a a aod ductus 
bcpation. 

a. From mpporatioofti 
odiUiig in tho We itaMagea, the' gall- 
free from stone. 

J. From rapture of the suppurated stooe^on- 
taininc gall-bladder into the liver with abacesa for- 
mation in the latter; or by »uppuratioo of the liver 
by perforation of the inflamed nll-bladdor. 

4. By perforation from the itoae containing 
«n Wnddiir intoadhorioM mhta these cover the gall- 
bladder and anterior border of the liver; and more- 
over whca the adhesiooa are intimately intcrminf^cd 
with the anterior abdominal wall. Such rupture 
usually oocnrs in the space in front of the iigatmrmimm 
trittmiuUn hepatis. 

5. After perforation of the gall-bUilder the pus 
may diffuse to the under side of the liver and in 
this way cause a subphrenic abacets posterior to 
or in front of the ligament previously referred to. 

Rledd thinks that such accumulations of pus or 
bile between the liver and diaphragm are compara- 
tivdy rarely rfTntctl through the agency of fdl- 
stones. Suppurative processes arising from hepatic 
calculi witn cholangitis (calculus in the common 
duct) may in some instances cause a perforation 
of the liver dome. Such a rupture is very rarely 
brought about by stones isolated in the liver when 
thenll-bladder and common duct are free. 

The most frequent cause of subphrenic pus or 
bQe coUectiooa is rupture of the fundus of the stone- 
containlag gall-bladder, with its extensive diffuse 
intcfbdags in the front abdominal wall. To 
remove such accumulations Riedd recommends 
that an incision be made below the twelfth rib and 
the thinner part of the ligament um coronarium 
sepa r ated witn drainage by means of a thick tube 
traveniiig the body from front to back. 

W. A. BuKKAir. 

Hoover, C F^ and BfattilMohom, M. At DIaoocteted 
J o nndlpa Ardk. Int. Mtd., 1916, xviii, t^ 

The term "djuofiafed jaundice " carries with it the 
inference that dther the pigment or the salts of 
bile formed within the liver are scoaratdy ahunted 
from the biliary path into the Ivmpn or bkiod-vcflKb 
of the liver. Thus far it has lieen shown that bile- 
salu may be shunted in tUa manner, but it b not 
jret certain that bfle-pigment formed in the Uver is 
separately shunted into the blood stream. Thb b 
what would be expected « prwri when the compara- 
tive facility with wUch the salts will posa throu^ 
a dialjndBg membrane b cooaidered, oa ■iwiwo by 
the c oBc en l r at i oiia of bile rc<|uiicd to vidd pigment 
and bjlea ah a, respectively, to the dtahrsate when 
coUocBoa sacks are emplojred for dialysb, and abo 
when the fact b cooaidered that the renal filter will 



yield bi b sal ts to the ttrine from a lower grade 
of rhoioimia tkaa b re q uir e d for bOe-pigment to 
apoear la the viae. 

The authors fooad trae diaaodated JaaafHce of 
hepatic origin in two caiea of primary ^■ff'nit 
in two caaci of lead poiioaing. In the fow 
failo-aalta were fooad ta the blood in large 
tWt ia, the qualitative test for bile-salts in the piaa^ 
BM dialyiate was quite aa strong as found in com- 
piece jaandice of proaooaoed aeveritv. 

F.Tipring ia jaaadfce of luemol>nic origin and in 
oooaplete jaundice which has undergone roaal <8no- 
datioo, the authors have never found btlo-pi gai eat 
without bile-salts in the plasma. 

Bilirubin and bile-salu may both be prcoeat ia 
very marked concentration in t he plasma aad neither 
pigment nor salts sppcar in the urine. 

Absorption of bilirubin in the plaaaui macy aot 
only withhold the pigment from the reaal filter, bat 
abo from the tissues; so that it may be proooooced 
chobratia (pigmental) without cboluria (pifmeatal) 
and abo without icterus of the tissues. 

When pigmental choUemia is present — in vary- 
ing degrees — w-ithout cboluria, the coUodioo sadi 
wUl yidd no pigment to an aqueous dialysate from 
the plasma, ^lien cboluria attends choUrmia 
(pigmental) the collodion sack will yield btle-ptg- 
ment to an aqueous dial>'sate from the p|f*"T^ 

Bile-salts wUl dial>'zc from plasma when no bile- 
salts are demonstrable in the urine. 

Wit hout an examination of t he plasma the assump- 
tion is never justified that bihary dements have 
not been retained in the blood. 

GnooGK E. BBuav. 



Ilellstroefn. N.: TwoOpantod 

Icterus (Zwd opetieru FacUe von 
Ikterus). Tr. XI Nmi 



tgi6, July. 



Nmtk. Smrf. CMf., Goctaborg. 



To 43 cases in the literature llcllstroem adds 
2 of his own and a of Borelius'. The results of 
extirpation of the spleen are good, as patienta fed 
well after the operation, are without angmic sjrmp- 
toms, the icterus ceases, etc The primary chaafsa 
in the blood-forming organs with decreased willt ince 
of the erythrocytes however does not improve after 
the operation. 

BoEEUUS demonstrated 3 extirpated spleeaa. 
In one case ictenu was absent, in the other it waa 
mild, hot hsmolysb was present in both. 

Rovsoro stated that 50 cases have been ob a cu re d 
in Denmark which shows that the disease b aot ao 
rare as b believed. He reported a caae of hb ova 
which abo showed gall-stones but these were left 
untouched. L. A. Ji 



GO. I. C: Sorisry of tho BO* Pbissjss (Ofumb da 

la vias bOains). iK#fwi^«4l^y or, Bogota. 1016, 

vii. 4«». 
The author saauaaiiaea the cases of biUary 
Uthbab treated ia thesvglcaldiaic of the Hospital 
of MedeUia. From the experience gained by the 



•Jp 



INTERNATIONAL ABSTRACT OF SURC;KRY 



ttwly ol Umm cmm Iw iUbIw the foOowtaf co»- 
dMMt CM bt dnwa m ittMib the lynnHoM of 

I. CakwkmfdOm giiHibifcWc or in iht qrMk 

t. TW icittw wMdl apptM* vitli colk or • 
Uiik totw, wMdi dfaMjpowitoulhr aad dot* not 



J. NtriilMt kimrm of vmrjrinc InicMily, boi 
hmooi ditriot colk, aod wKkH ponly diiop- 
obMroctios of tW comnoo duct by 



mad 

obtlfUCtiOQ 



4. FiwteMt ktorwiidi doy 
•ccoMpoMtd by colic tifUW 
of ibt coanmi doct by itUlMd 

$. PunlMoM ktorw witboot a bfatonr of polnful 
aWi or tobddfaiy ^yipto—, oad whkb b not 
■owyoiiH by cBlk i^ilJii cowpr—ioii of tbo 
CMMMtt diKt noit cooMMaly by o luaor of tbo 

Wbb icfftid to tbo pll«bloddcr, tbe auibor 



I. to obalfvctioo of tbo cyatk canal ibe gall- 
bladdw b ^tJurrrM. tbt bOe wbkb it cootaint b 
fOMMbcd aad tbo faiflaauoatioo iocnoaca tbo <|uaii* 
tity of oraan. Tboio b ■aifly ohte r re d cxtcmal 
tosMlactioo, atMiblo ott palpalioo, but tbere b no 
ictorva nor livar bypaitrophv. 

9. If ibcrrbprnvoiafoctwo ihccootcotabocooM 
ponikot. tbe diatatioa and external luoMirprafNa- 
ihrdly iacioaao; tbon b mat ictttibilUy. muscular 
iiriiliirii, aad bipolotoitc fovor. 

5. la Dortbl or oonplete obairactko of ibc 
ooouBoa doct. tbe gall-bladder beiaf bealtby and 
tbo cysik doa permaobir. the liver lacioaaca in 
iiae aad tbe giO-bladdcr dbtcnds. SoBMtbaee in 
Ibb way aa «aoraioM ttuaor, nacbing to the iliac 
aoM, b fonaod. However la tbe great majority 
of €■§«» 80 per cent, tbe gall-bladder bas pre- 
vioarfy boea tbe uie of a cbrook iaflaauaatioo aad 
oa tna accoaat b commoaly aaialL 

4. Wbb mploaa of obeiractka of tbe coeuBoa 
dact tbe aiB waddrr appean coatiactcd io 80 
per ceat of caeea of bfibfy Utbbab and dilated b 
90 per croi of caaea of coaqMOHioa by tamor. 

All the above coac lari oaa are of great value io 



Sai|kal uoalaMat aoooidiag to the author b 
bdfcaied (1) ia freqaeat atlacfca of colk; (1) io 
dyapepik dbtarbaace prodoccd by Utbkeb; (j) to 
caaaa of dlatatioa of tbe gaB-b la ddor by obatrac- 
tloa of tbecyatkdact; (4) laroniplkatk 
lar OMpyoaML e idcalir nytor- ^) ia 

real caiaa; (6) la caeca of cavot. > bv co 

dact obotfvctloo within certain jimitetfeni. 

(7) ia caeea where tbe dhgnmb b obecare 



aad oipliMoiy ooUotoenr b dMfaabla> 

Tbe haWraitoai for onlocyMoaioanr aio: (i) 
wbea Ibe fal-bladder b rdaUvoly bealtby Md Ibe 
cviifc dad miBMibb: it) fai cao« of laMireBii aad 



wnen ine gaU'iMaaaer m mu4 

oat aad tbe patbat aaAtted 

ladkatloaa lor cbolecy»tc 

Ibe fdl<bbiddir b tbo Ao c 



when tbe gall-bladder b much iadaoicd and adbcr* 

for a radkal operalloa. 

trctomy aft: (l) wbMI 

tdl<bbiddir b tbo die ol lever 

alceraicd; (1) wbea ibe galpHaddor b 
apoa a caIcuIu* and ibe nmk daci obMractod; 
(j) bi certain caeea capedaUy la older to caie aa 
riteraal Aatala; (4) b aaodatloa wbb cboledocboo* 
toour or bepaloetoaiy wbea iauierallvo* 

Caolodoooboioaiy aad caolocyitoaloanr aio 
Indicated: (1) wbea tbe calcah» b wlalaedTTirfalMi 
of tbe common duct, eiliaciloa of cafcalaa, catfsl 
tuturc in two planea, cbolecyitoiloaQr for dralaafe: 
(j) when the gall-Uadder » amcb coauacted aad 
adbereai, cyatk doct obeUadod, and a calcalaa fai 
the coauaoa duct. W. A. 



Willi Torelaa of 
Feilcli for Toil Moatba (Rate pralab4« avoc 
tonbo do pidkob dnob dh OMb). Mm, t^dt 
tUm, «f df IMro^., 1916. ass, s6t. 

Tbe author reporta the caee of a woaua of 10 
who ibowed qrauAoaia of an abdominal laaMir tbe 
diagaoeb of wbkb waa oocertaia. Voadllag. 
intenae veatral paiaa, aad Iom of ooaicbaHaia bad 
been ialeradttently preeeat for tea laoatbi Oa 
making a laparotomy tbe author fonad ii^Jaoaat 
to a greatly thkkened and adhereat cp lplooa aa 

by ita coavei face, ^le aader face waa taraod ap 
with difliruUy on account of Its coaaocUoai wita 
the small intntine. uterus, etc., and a podkle waa 
found the sixe ol the arm of a fottua. 

The splenk vemeb were completely obliterated 
for about S or to cm. The author reeected the 
whok maee ami the patient recove r e d witboot 
incident. 

Tbe author calb attention to the fact that tbe 
organ bas apparently been mbjcctcd to toraioo for 
a period of ten mootba without being attacked bv 
gaiwreae or giving rise to any symptooM of pert- 
toaitle. W. A. BaaMMAM. 



HAOMfartlc lcienia« aad 
J. Am, it. Au., 1916. Ixvii. 



cyMic dad 
a^loooliib 



if tbe 



are perntaiblei (3) 



Mlllert J. L*t BpleBOCtoaQr la 

iiuHOi ■ vvTBoem. 
7*7- 

In bcmolytk ictenia bik b anially present in the 
blood, but tbere b no arobOfai; wbfle in the urine 
bik b abaeai oicepi duriag bamolytk crisea. but 
urobOia b pieaeat. Tbb peculiar coaditioa b aot 
praeeal b oilber of tbe other two dieeaaaa. 

Soooadary aa«aia of greattf or km degree b 
cbaradcrialk of ipleak aa«ab aad b aa iul ytk 
ictema. bol b aot prceeal fai Baaot'a drrboib. 

Urobilin in tbe etooL uiaally noarfrtrrerl aa aa 
index of blood deatractioa, b graally faKsoaecd ia 
bnaolytk icteras. Eppinger believea ibai tbe 
aaMNUu preecnt ia tbe aonaal etool b from 0.1 a to 
ais gOL, wbfle ia three paiirni* with hsmolytk 
IclOToa tbe aoMaat varied from 1.3$ to 3.8. 

In ibeee ibree coadhJoaa. whkh are ia BUMy waya 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



131 



•o doMly ralated, U b «t pmeat inipoMihlB to ex- 
pbiD why in Hanoi '• drrhoab there it ktenis with- 
out amrmia. in splenic anrmia there b an«nia 
without ictenn, aad in h«Dol)rtic icteme there are 
both ictcnis and uurmin. althoudi in utMuy in- 
•lancet kterw la the dooioant cooditioo. 

The daitificatioo of all tplenic tumors with chronic 
anvmia under the grnrnl haul of splenic anarmia 
may not Ix logioal. hot from a therapeutic point of 
view such a grouping may be detirable, as there is 
iadisputable evidence that cure hat been effected 
in the vast majority of patients clinically diagnosed 
as having splenic anirmia. on whom s plenectomy 
was pcrforrocd. Even when the disease has ad- 
vanced to the point of marked hepatic cirrhosis 
and ascites, more or less complete return to ix>rmal 
hat been reported. 

The resultt of operative measures in the early 
stage of the diieate are excellent. Griffin, from the 
Max Clinic reports the cases of five patients, three 
whh urrhotis siiMi ascites, and two in the preasdtic 
stage of drrhoais, on whom s|>lenectoroy was per- 
formed, and four o( the live returned to normal 
health. One of these patients with ascites has 
been well seven 3rcar». In the Mayo series of eight- 
een patients, two died, or 11 percent. Twelve of 
the suteen rrcoverinK from the operation are now in 
excellent health (iQi 5); two an v improved; 

one at first improvetl, later dt .iscites and 

died, and one died two years aficr ihc operation, 
the cauae of death not being determined. 

Appearing either as an acquired or familial con- 
dition, the first symptoms of hirmolytic icterus may 
develop either at birth or during eariy adult life. 
The characteristic sympiuni.s. outside of its familial 
nature, are the chronic icterus of fluctuating inten- 
sity, combined as a rule with var>'ing degrees of 
awrmia ; greatly enlarged spleen, often moderately 
enlarged Uver, urobilin in the urine, but no bile 
except in some instances after a hemolytic crisis; 
the stools well colored, with no evidence of biliary 
intoxication, as pruritb and bradycardia, and the 
presence usually of a lowered resistance of the red 
corpuscles. The disturbed resistance of the ery- 
throcyte, which has been coundered so character- 
istic of this condition » not always pcesent. 

The usual pretence of lowered resistance of the 
erythrocytet and the relation of the s|)leen to this 
ph en o m enon stamp lurmolytic ictenu as having a 
probable etiolofic reUtion to the spleen. It might 
be conside r ed that as the normal spleen tends to 
lower the resinance of the < • > hemolytic 

agents, an enlarged or ling spleen 

Bight increase thb tendency 10 5ULb a degree that 
hnmolytit would occur from a variety of ndldly 
kMnolytk agentt normally present. 

Splnectomy b undoubtedly curative. The op- 
erative mortality in forty-eigbt cases was only 4.1 
per cent. The forty-six patients who recovered 
from the operation were cured. The jaundice 
rapidly disapp e a r ed, beginning within a few days, 
and as a rule being complete within two wcekt. 



The r ecove r y from the amrmia was somewhat slower, 
but relatlvdy rapid. 

True Hanoi's cirrhotb b rare and bean tome re- 
semblance to splenic an«mia and harmoljrtic icterus. 
It would appear probable, however, that in Hanoi's 
cirrhotit, a c o n dition whkh haa heretofore been con- 
iidered incurable, s pl enect o m y waa indicaicd. 

C. G. Item 

Leo, R. I.. Minot, G. R.. and Vincent. B.t 
Sple n e ct o m y In Pernicious .\nirmla: Scudlet 
on Booo-Marrow Silmulailon. J. Am. M. Au., 

IQ16, bcvU, 710- 

The authors report fifteen caaet which f 'M ^M1^e 
all the patients with pemicioot anemia operated 
on by splenectomy at the MasaachtitetU Goieral 
Hospital from November, 1914, to May. iot6. 
One patient with a red count below 1,000.000 died 
the day after operation, presunubly of postop- 
erative shock. Theie were no other immediate post- 
operative deaths, thus giving an immediate op- 
erative mortality of 6.6 per cent. Of the patients 
who sur\'ived, one case was too recent to afford any 
data. Of the remaining 13 patients, one. operated 
-upon two and a half months a|p, b still in the 
hospital on account of thrombosis. The other 12 
left the hospital three to six wedu after operation, 
at which time the large majority presented no great 
change in their blood counts, although they all felt 
better, looked better, and were less yellow. Four 
patients showed considerable immediate and pro- 
gressive improvement in the retl counts and hirao- 
globin. The condition of these 13 patients was 
ascertained as far as possible two months after 
operation: 3 had not changed materially; one case 
showed a slight increase ud one a moderate in- 
crease in the red cells; 8 showed a marked increase 
in the count of red celb. The red counts of these 8 
cases average approximately 4,000.000 cells, with 
a general improvement in their clinical condition. 
In these cases it was noteworthy that the dlagnoib 
of pernicious anemia could still be made from the 
blood films. 

Of the 13 patients there were 10 in whom six 
months had elapsed since operation. At the end 
of six months 5 of these patients had a rdapse. Of 
these 5, at the two months' period 4 had presented 
very marked improvement. The fifth patient 
never showed any great improvement. 

At the end of a year after operation no informa- 
tion could be obtained concerning a patients. 
These 2 patients, however, had had 00 relapse 
within six months. Of the s remaining patienu 
only one had gone a jrear wtthout relapse. Thb 
patient, however, suffered a typical rclapte and died 
sixteen months after spl en e ct o m y. One of the 
remaining 4 died sixteen Bsontht titer operation in 
a tecond relapse. Another after sixteen montbt b 
now having a vkty seriout relapse after tevanl 
minor relapiet and still another is in hb second 
teriout rehqiae at the end of the year period. 

The end-results of splenectomy in the authon* 



IJ» 



INTERNATIONAL ABSTRACT OF Sl'RC.KRY 



CVftaMjr ill lO llMNr MIX 
fMMiS IffOM llni pivctdWi TWjf OMt^W llMt IIm 
fVfMMl punim of tiM diMtM ii Ml rliiittil, 
WwmfcJMi. ii it ft tcHkliv obi^nbi tluit la 
• «•! «f I J CMM tlMTt VM caMMtnMt iMnpoimffy 
Ii l«o aoMkt, wUdfeptffvltlad ki 
•f Ikt csMi «p to rii muIm. Tfciilwpiow 



tiow fai Um 



•ft 




nuktd tiMS ikt 

ll MHMd to occur nitlwr 

■no* ipHMCiOBUr • 

ObMWillOM OS iIm Mood dtOMBt were M 
foBowi: f^MoiWiiAr thm iplMtcloay liierv »«• 
ItMocytflilii. vMyMf froM 10.000 tojt^ooo with 
am twwmd poliroocltftr pwwtotft, ThMocrurrrd 
wityn ivrotv-ioor Imoi* ftfttr ipliMCloaiy and 
niWJiil •ithio a ftw day*. Tkt MttlMHt found 
llMt pvriMMlly after inlimctoiiy tlicfe waa a 
" to a B^tovirt of thawhite 

, tMBOCCWiod 10 iImwmI coiiioa of pacwicwwii 
Tto fmamm «■• bock IjraiplMertk and 
Tkt | wi ly mci f p ko nn clto r caOa 
tcadod to giVt a bohmU Araetk 
Packot* vitb the highcat Icucocytoaia 
to iko» tkc grealcat laproveneol after 
aad ofoiod a ro«^ mcaaa of cMioMt* 
lit tkt fotort raactkMi of tkt rad ciH formiag 
part of tkt but vmtnm. Sock ffani MMHt to 
tkt aotkon tkat a Ptrrirtimly mr p o bowrp ko' 
•■ciaar cooM la ptrvickNia aaMMa itol valoe aa ooe 
of tkt ladkaum i»f iNiat ammo iiikaailiim Like 
tkt W a uiCJt t cooat tke number of pUidett in 
fntnl faBowtd fkt carre of tbe red cdU. Tbc 
platdttt ikowed a dafbdit Incriaii tknt to aevta 
dava afltr iphatrtniay. Tkia tariaiii ataally 
laua tkt plataltti abovt tkt aomal, aa b oat of 
tkt aatkon* caaea to 900,00a Tkr aotkon wot 
taipraBaad by tkt atciatioa of ibt faKreaat of 
pliltlrti aad tkrnmbnalt Tbioaiboaia or phlebitis 
«aa aocod in 3 of thdr caota aad tkqr are inclined 
to bdbvt that tkc ihroaikoaii b bi tooK way related 
to tkt aurkad laaaaM of piatdtta. 

HowtU-jo^jr kodica occo n od coaMaatJy in every 
catt after optratioo. Tbcaa bodiai oaaaOy ap- 
ptaiod la SBaD aambcn tke day allor apltatctomy 
aad padoaBy iacraiitd. la aoao famanrra as 
per oeat of tkt lod caBi coa ta hi ad tkeoL Tke 
■Nil fT i ilnit waa fron 9 to 10 aad tke per- 
caataft lactaatcd Tke autkora are faKliaed lo 
kcHtvt tkal tktM bodita arc related to aa tocwia t e 
of bwii Biaiiiia activity or to iniutloa. 
Of ticatta, leakowadatkovcrof bbattof vary- 
a 1^ daya af tar optratioa. Tktiadlap 
t aad tkdr pnatwit ovaa bi 
lataayataftof tkt< 
beanr ii aoc coaridand of 
aa to tkt Man coant of tkt • 

I of fHkafauod tad cdb b takaa aa 
tMaiv of JBaiDpDlirir activity of tkt boat- 
roar. Uadtr aonaal caaditlaaa aboat oJ par 
of tkt lod cali are lallcalatod. latkt«oa- 



kif altar 



P«My 



of 

of micalattd oalb prabaMy 

activity oa tkt pan of tkt 

tkat pfodacM rad eala. 

two to tva days altar ■Itamoanr la 

tkt aatkora kavo laaad a 4ikt 

fai tkt ratlcal at td c aMfc Tkt taai- 

la attrlkattdtotvo factora: (t) an 
aaaociattd dfaafanMloa to tkt 
(f) aa aaaoriaied lacriaat to activity of tkt 
OMrrow. Certain »iimuUtlat dbcu afttr ipltatc- 
toaiy are teen almoM im m t dl i l t ly . aa to tkt eaae 
of the increase in the [ 

The increase in the platdtCa'ttada to oociir 
what later, and the main lacraaat of the rtticalatad 
celb. when it does occur. MtaM to be iaaafarattd 
still later. Tbt aatboct ooadade tiMt tkt illaiala* 
tion of the Ixaia iniiiiw b aaaaOy aaanrbtad vitk 
improvaaMBt, whether after traaafarioa or after 
splaaaetoanr. Splenectomy nwai to raaalt to tkt 
neatcat atnaabtioa of tke boae>Burrow of aav 
koovB tkerapcotic aiaaaara. It acta oa tke wkolt 
booo-Burrow aad aot oaly oa tke portion tluit 
fonaa red ceOa. Hoarevtr. ip b nec toawrdoea aoc 
alter tkt caatatialcoafae of tlMdieoaae. WUtoraraa 
cooataat atiaittlattoir eftocta are seen after iplaate> 
tony, aay individual caae of bone-marrow atiaiato- 
floe after ^>leoectomy auy be roughly paralltltd 
with a caae of boBt-auurow stimttlatioa tkat 
occ u rred dther spontantooaly or after traaafailou. 
It it evident that from ■pbatctoaiy oae caa 
attato atimulatioo but once. TraaaftHloa. wblk 
ptrkapa of 1cm coaatant and of Icia actlvt 
aaa two creat advaatagea. It b relatively 
aad caa ot rcpeattd a anmber of tinica. Traaa- 
foaioa data aot OMidify tke destructive aaraciaa at 

C. C. Havn. 



Traaiad by 



McCtato, R. D.t 



of Mood; Tranafaalf to 

J. Am. M. An.. 1916. fatvfl. 7^5. 

McOara biia^ ravitwi tkt atai us of bloods raaa- 
foiioa to p t iBbl oai aaaada, citing foor caata, oat 
doe to btttwl poboatof. 

Sioca 1666, wkta Itaarfarioa of blood waa fiat 
tried bv Jaaat Baptbt Dt^ya until tbt pnatat 
date, tab prooadara kaa baaa tried iaaaaMrable 
ttoMa, bat wbk oaly todUteaat raaaha. Lack of 
qrataaMtic traatseat aad cara to aaltctiac tbt 
pioptr doaar ara tkt drftf natoaa lor faflBR. la 
1870, Saadob dbcavand tkat aO blood ooaM aot bt 
aatd, aad to 1910^ Mora aad Jaatkyfoaad tkat tkt 
tod nib of oat ladlvidaal any kt camped by tkt 
nnua of tkt ocktr; tkat tkan crib any bt toinn 
lyatd; aad tkat kanaa batofi an dMdtd tola foar 



daana by tkan beta. TkwJon tkt nto ct laa of 
tkt doaor bof anat haportaan, aot aaly to pn» 
vast MilailaaihMi aad kHaoMa bat abo tbt 



of canato 
Mood. i^.eypkOb aad 



to tkt 



CENEIt.\^ SURGERY ~ SURGERY OF THE ABDOMEN 



»33 




A caie of beniol pobooiof U died; the qrap- 
toms being tboM ot a severe purpura hirinonrugiGa 
with an aiuBinia of the apUatic type. Repeated 
traoifMioaa itaoUed in a complete core. 

Fofiowittg this caae the OMthod waa applied to 
sevcateen caaea of pemidoaa anamia with the fol- 
lowing resulu: 

T*ua •.— iMviT or •fai—iwii— ■■ 8 » » M i — Cmh e» Pn- 
.Ahmu. SomKfoea TtAmnmam B&um Mam «na 

MMkw NrCM 

.' M U 

U »i 

? «o 

f to 

la 19 

f to 

I IwMt M kMM alltrinMlHlM. i iK 

• iH 

-. . » 4X 

. ilrr*lia« ««W IM t« l« 

T to 

IhrftCMM. 

The results in this series have been so encouraging 
that the author feds that life may be indefinitely 
prolonged where this systematic transfusion of 
blood is used in conjunction with splenectomy, 
the number of transfusions depending upon the 
hemoglobin reaction; 75 per cent being the lowest 
and 90 per cent the highest consistent with good 
results. P. M. Ouaa. 



Krumbhanr. E. B.: Lata Result* of Splenectomy 
In Pemidoaa Aninla. J. Am. XI. An., 1916. 
Uvii. 7*3. 

It b interesting to note that Eppinger was led to 
adopt this procedure bv observing after splenectomy 
a diminiahed output of urobilin and other evidences 
of decraaaed hemolysis. Decastello. on the other 
hand, had noted the improvement that followed 
splenectomy in the related conditions, hemolytic 
jaundice and Banti's disease; whereas Klemperer 
waa influenced by the clinical observation that 
qrfenectom^ for such conditions as rupture of the 
Iplees waa m some instances eventually followed by 
p<rfycythjemia. 

Of the 15J patients studied. 10.6 per cent died 
within six weeks; a dbtinct improvement in the 
dinical condition and in the blood picture occurrcxl 
in 64.7 per cent, and no improvement in 15.7 per 
cent. 

The rather high postoperative mortality — prac- 
tically 30 per cent — may be due to a poor choice of 
cases in the early series. As a much greater pro- 
portion of the more recent cases have survived 
the operation, the true postoperative mortality ia 
probably much leas than 30 per cent. 

Of the individuals who showed improvement 
shortly after operation, nearly two-thirds of the 
total number, a large number have failed to main- 
tain this improvement or have since died in a relapae 
or from intercurrent disease. 

.\lt hough a few caaes have continued in good 
condition during the period of observation (over 
two yean) in no caae can it be said that a cure has 



been effected, and the blood of these individuak 
continues to show many of the characteriatJc aigM 
of pernicious anemia. 

On account of the improvement that follows 
splenectomy, it would appear to be not only a 
Juatifiable, but in many cases an advisable pro> 
cedttre; but in no case should a cure be promised or 
the operation undertaken except under the moat 
favorable conditions. 

The beat reaulta ara obtained if the operation ia 
preceded by one or more transfusions, and thoae 
patients who relapae after operation will be greatly 
hdped by transftision. Whether or not transiuslona 
would have produced ec^ually good results in the 
absence of splenectomy u a question that cannot 
at present be decided. 

The moat favorable results may be expected in 
individuals who have not passed the fifth decade, 
in whom the disease has not pro^rrased for move 
than a year, and who have a rdativdy good blood 
picture; that is, an anemia that ia not of too extreme 
a degree or of the steady, progressive type. Individ- 
uals with enlarged spleens have done better than 
thoae in whom the q>leen was small or of normal 
siae, as have also thoae suffering from an anemia 
characterized by excessive hemolysis. 

The opposite of these conditions should be con- 
sidered aa unfavorable factore, as should also the 
existence of spinal cord symptoms or the presence 
of an aplastic bone-marrow. C G. Uxvo. 

Peck, C. II. : Splenectomy for IISMnotytic Jaundice. 
J. Am. M. Ass., tgtty. Uvii, 788. 

In reporting three cases, Peck reviews the sub- 
ject of splenectomy for hemol>tic jaundice. 

The accumulating evidence of the results of 
splenectomy has proved the etiologic relation of the 
spleen changes to the disease, although the exact 
nature of the process is more or less obscure. The 
presence of bile in the urine indicatea complicating 
disease of the biliary tract. 

Hemolytic jaundice is of two types: (1) congenital, 
which is usually of the familial type; and (a) 
acquired. The symptoms of both are practically 
identical, however. 

A detailed account is given of a case of the 
congenital type, but non-familial. After two open- 
tiooa for supposed biliary obstruction, the diagnoaia 
of hemolytic jaundice was made and spl e n ect omy 
performed, with immediate disappearance of the 
jaundice and lasting improvement in the blood- 
picture. The case presented marked fragility of 
the red cella, no itcning. slowing of the poise, or 
praaence of bile in the urine. There waa modeff 
splenomegaly and anemia with increase in the 
number of reticulated red ceUs; urobilin and 
urobilinogen were also preaoit in the urine. 

The aecflod case was of the acquired tjrpe with 
symptoma aimilar to the first, but not so marked, 
aa tne diaeaaa waa of short duration. Splenectomy 
was followed by prompt and complete return of 
health. 



IM 



mriRMATIONAL ABSTRACT OF SURGKKV 




SlMMCti 






iMi hMMnrtic 

It C«l bt 4 



cimd bjr 

P. M.CftAM, 



■tf Kats, 1.1 A 
ItBMiljTir Jwaci Willi 
Am y Alt . 191^ Uvtt. i«^ 



J. 



TW caw b rvporttd ol a malt, Mid 18, a uOor, 
wWu, boni in tontlMrB luljr, tifhtcvn hmwUm ia 
iMi cavMiy, wIm Am cuw vader ibc obacrvaUoa 
of Um VaadifMt OUk Kowiwbii q, 1015. There 
waaaoyMMyoficunMtatbtltaiy. Ileludbcea 
ia good inwral ImoIUi oati dria BM»d» pfovfouft, 
Miucib. iQis. «lMil»MtkodtlMthi»tkiaoad«y« 
wt mbrr fopidhr boooauag waoa c olo i od. Ia 
■boal two doyt tie kaadko vat docp, ho fdt 
drovty. wot oook, oad hod to go to boo. Oa the 
thifd day he hod high feverjtwoot o good deal aod 
had aevofal diMiact chflla. The high (cvrr with the 



aad twoats pcniMed for two wccIls, 
dvriiv fvhkh tlBM ho romainod at hoaie aad in bed. 
The ydloor dJ a ca lo t a ti oa of the lUa aad mttcoua 
mmlrFr h u a a io i, vhkh had by thie tiaw 
baoOBW IcM iatcaaOt waa aefocthdcia onite aiaffced. 
At the ttcginnlog of thr third week the fever, twcots, 
aad chilb dccfvtticd in tcvcrity aad tlie potieot 
hit ororii at wliich lie reataiaed umO hit 
to the Rootevdt Ho^rftal, November, 
t7, 191 $• DuriiM thit entire period he had a daily 
toawcrature of Iroa oq to 100*, wliich appeared 
lagJaflj b the aftcraooa, piocaded by a tlidit 
dSllaitiiv for about fhre aUaatca aad followed by 
aweatinc. At no tino did he have itching of the 
ahia. rot a few moatht prior to hit admitaion to 
the hotpital, in addition to the imMoow awatioaed, 
he compUiofd of a heavy fecUag, di tt oati oa, aad 
toadcfacaa hi the rnigiairiMm Theae apoaaved 
aboal half aa hoar after meah aad coathMwd f roa 
toa to twcatj adaotaa. 

Whea a a a aJ a t d hit polae waa 7*. tttpi ra t i oa 18. 
aad teottiamiofe too*, lib nutriiioa wat fair. The 
iUa aad vUble mocoot mrmbranea were diatlactly 
ktcrk and there wat a lUght aaw raah oa the 
bach of the cheat. The toagno, toeth, pharyan, 
taaalt. aod ryrs were aonaaL The heart aad 
hmgi were ocgattve. The a h deai e a waa rdased 
aiTthefc waa dight ttadwa— fai the cpigaatric 
lagioa. ctpacially to the kit of the addliae. The 
Ihor waa aol palpable aad. oa i i i i trM ati na , did aoc 
aaeai to bo calafftd. The apkaa, however, wat 
dlnfertly ealaned. the aharp hMMr border being 
Mt aaar the nhOiae aad laarhliig ataaoat to the 
the lower pole bciag 4 Mfhca above the 
of the iliuni. The iiiiaalilMri waa aboat 
tht aaifocc oaoolh aad aot t— der. The 
ffrtrwpM ff^g ^iHi fcscscB v^Mi0 sowIbsi* 

WoiiBitwi 0. 191 $. (he blood eiaadaatioa ahowod 
hsaiagtohia 68 per cent, erythrocytaa 4.] 
aad Icacocytat 4.Ma Slight p(cdlocyt< 



praaaat aad the nvaatioa of tho lod hlood'CaOa 
waa OMfhad. No pigaiaaiad or other abaoraad 
ary thiocy tot were loaad. Bhwd wkhdrawa for 
Iho WitatrwiaaB loactioa alto gave atgallw 
bat taau for bBirabfai hi the Uoodaann 
ttiaarty podthro. 

Altaoagh ffBaatgtaothatapy waa coatHaiod* a 
tplaaactomy waa advjaad. llrii waa doaa N< 
bar ts» 101 s- Under othar aaaail 
waa OMde aloai the left bordar of the left rectaa 
mnade from taa rib aMigto to the umbOicoa. 

Ibtr, 




Palpation of the gaO-Maddar, aall-docta, 
ttooMch, aad paacioaa waa nagitTva. The 
wat cootiderably aalaifidL trai, bat aot iadaiinod, 
and fairty free from adaarioat aaoq^ aloi^ lu 
poaterior bordar aad to a BMiderato ciirot at the 
npoerpole. The adhcafoai ware freed, allowing the 
ddtvary of the tpleen forward. Tha podida of the 
iploea wat thea Ugated aad tha aplaaa laatovod. 
It wrixhtHi 800 gm. Tha wooad waa thaa doaad 
in the usual manner. The operation waa wall boraa 
and the patient made an uneventful rec o v er y. It 
is interesting to note that the icterut bogaa to ditap- 
pear immcoiatdy after the operation aad wat 
almoat entirdy gone at the end of a week. Four 
weeks later the patient reaomod Ua work. 

The rcsultt obuined by the t pleaactoaor were 
ttriking. Two dava after the operation. Nove mber 
»S, the white blood-cdb rote to Hjooo. The 

Kilymorphonuriear Iaoooc3rtet were 8e per cant, 
ovembcr jq. hamoglobin 88 per cent, rod edit 
5.110,000, the color index bdna 0.9; totd numbar 
of leucocytes 11,00a Dtecmber x>, aboat oaa 
BBonth Later, the blood count thowed: hmtodbfala 
80 (ler cent, the total count of red ocOa oafalg 
5,440,000. The white blood-cdb numbered 18,60a 
The patient, when laat teen, March so, 1916, 
had no tubjective qrmptoam, aod there waa no 
dgn of icterut. The blood and urine were normal. 

EowAOD L. CooMatt. 



Lockwood, C D.: Surgical Trcotatont of Boad*a 

■*• fr. MVii Smrg. ,tii . St. Paul. 1916. Dec 



Splencctooiy hat bacoaw a well wf i y iaa il pro- 
cedure. A aafadaat aaaiber of aphaactomlea 
have aow beea p a i lonaad to catablith opoa a fairly 
g ft iift boab the iadlcatioaa for thb operation. 

The auihor't coatribotioa b baaed apoa a cardnl 
review of the liirmtare aad ohacnralHaa ia thrre 
caaca. A btkf -n of ihe^ 

ploved b dvca. . rectot iaddoa 

eatbdy aaeqoaie lur t hr rcaioval of aB thiaa nlaaaa 
ahhoagh two of them were way laiga. Spadal 
cauhadt b laid opoa tha faaportaaca of ttg^ii^ 
tha ^daaic aitery before raaoviag the yl at a . The 
aplaaa waa d al iw e d fay aadrrUnx ii »iih the arm 
aradi aa oaa woold pick op a large watrrmdon. 

In two of the thrre caaaa npoitod a laige aawont 
of blood waa kitt from tha ^liaaa after iu rcamvaL 
Thb Mood waa coOccied ia a atcrik batia. It waa 
thaa citrated aad reimrodooad faHo the paiieat'a 
wUh marked beadkid reaolta. Thb method 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



>35 



ci autotruafMioa wm thought to be original, hot 
oo looking ut> the litenture it was found that 
Lichtrn»tctn had rrportcd several caaca d auto- 
tranduikNi fai rvpcmed extra-nterine pregnancy. 

The author tken rcporu in detail 3 cases of hb 
o«rn and rrviewa m caaca collected from the liter- 
ature which have been reported since 1908. These 
4a cases show an oprrsuve mortality of 14.5 per 
cent as against 10.5 per cent in 61 cases coUcctcd 
by Dr. George B. Johnstone prior to 1908. 

MISCBLLAIIBOUS 

franchlal, A.t Subphrsalc Abscess (DrU'ssccaso 

•ub(rraico). Gtn. d. Mf. € 4. tiiu., MiUao, 1916, 
itxvti, 1074. 

The author reports six cases of subphrenic ab- 
scess which he operated upon, three of which are 
ascribed to a gastric or duodenal origin and three 
to suppurative hydatid cyst. 

The clinical variety of subphrenic abscess having 
a gastric or duodenal origin b that most frequently 
met with; and its s^rmptooutology b so character- 
istic that diagnosb is relativdy easy. The onset u 
rardv insidious and b secondary to perigastritb or 
duoaenitb following inflammatory neoplastic or 
ulcerous pro ce ss es . As a rule objective manifesta- 
tions of subphrenic collections with perforations 
are situated on the left side, but in the author's 
cases thev were on the opposite side, probably due 
to the pcimary lesion being situated in the pylorus 
or duodenum. It b very difficult to determine the 
exact anatomic point at which perforation occurs. 
In the author's cases he decided that thb wss not 
in the anterior face of the pylortis or duodenum, 
because in such an event a generalized peritonitis 
would have ensued. When, on the other hand, the 
perforation is on the rctropyloric or posterior 
duodenum, the acute inflammatory process finds 
the aiutomical conditions very favorably disposed 
as a barrier of defence against diffusion into the 
peritoneal cavity. 

As regards the cases of suppurative hsrdatid cysts 
the author b doubtful if thine should be rcgaided 
as true subphrenic abscesses, as he prefers to restrict 
that term to pus collections. When cjrsts of thb 
kind give rise to subdiaphragmatic abscesses, which 
b rare, they should erupt in the tnterhepatic sub- 
diaphragmatic space, but in hb cases tne author 
found hunself unable to verify this rupture. 

With regard to the operative treatment of sub- 
phrenic abscesses; thb must be subordinate to the 
iituatioQ of the abscess. There are cases in which a 
, dear epigastric or lumbar evolution does not permit 
[My doiabt ss to the procedure to adopt. Where the 

■a has a deariy thoracic development the tiaas- 
[plcurodlajphragmatic route with resection of one 
[«r two ribs must be selected ss guaranteeing the 
best outlet for the products of punilent secreuoos 
and avoiding the daiofer of peritoneal inv ol ve m ent. 
Thb route is considered better than the antcro- 
abdominal route for cases of sbscess of gastric origia 



as it afords a better dfihwar. The iadaioa can 
be posterior or lateral, fSBerally in the neighborhood 
of the ninth rib, acoiidiaf to objective signs snd 
the results of exploratory puncture. The length 
of the iadskm aliould vary from 15 to 16 cm., 
eoottgh of the ninth and tenth riha being resected to 
afford suflkiently low exit for secretion products. 

The author does not consider that operative 
po en niothorax b a very serious dancer and in any 
case it may ttsually be avoided or reduced. He hiu 
in all hb cases used local anaesthesia (novocaine) 
and to thb fact especially, as well as to the post- 
operative care, he ascribes the success which at- 
tended all six cases treated. These cases were 
exceptionally grave ai»d Franchini b of the opinion 
that a different procedure would probably have 
resulted in some failures. W. A. Bbkmvam. 

Scibert, O. J.: Diaphragmatic Herain. Smrt-. 

Gjntc. (rObit., igi6. uiii, 465. 

The author reports a case of diaphragmatic hernia 
of the stonuch in a woman 68 years of age. The 
condition was apparently of congenital origin, 
although four successive protracte<i labors may have 
had some part in exaggerating the condition. The 

Eatient has had more or less stomach trouble all 
er life. Thb has become p rogr es s i vely worse since 
her first confinement, 30 years ago, and especially 
so in the last ten months. The clinical picture at 
this time was that of pyloric obstruction. Roent- 
genographic examination showed the entire stomach 
above the diaphragm, behind the heart. There was 
no respiratory embarrassment nor cardiac dis- 
placement which are usually found with diaphrag* 
matic hernia. 

.\t operation the stomach was found in the 
posterior mediastinum, with the pylorus bound to 
the margin of the orsophaKcal opening, which was 
sufficirntly large to admit the entire hand. The 
stomach and pylorus were released and replaced 
into normal position, the diaphragmatic opening 
closed with interrupted sutures and a ventral 
fixation done. The gastric symptoms have entirely 
diMppeared since operation. 

The report b illustrated with roentgeoogfaat 
and drawings and there b a renew of the literature 
on the subject which shows the extremely few ca se s 
recognized prior to autopsy and the still fewer cutm 
effected, even though the condition b not nearly so 
rare as b usually supposed. 

Prii^, J. II.: Report of a Case of Haraln iaio tiM 
Paraduodmal Fossa. Cfufww If. /.. 1916. 
Ixxxvi, 65. 

Pringle describes the paraduodenal fosss and ve- 
poru the following case: \ man 40 years of aae, 
previously well, had had three attacks during tit 
preceding year of severe pain in the epigastric area 
foUowiiMt the taUnc of food. He would voarit 
graen hffious naterial and be unable to work for two 
weeks or non. He had lost cooaiderahle wdgkk 
emaciated. The upper abdomen 



IJd 



INTERNATIONAL ABSTRACT OF SURGKRY 



mhm lull . wUh • Q^^blt tttmor lo ibt jtltlyw 

■CM ia ibt futfk coaton. At opwittai two 
««f« looad. ihr Urfef bciog bthbd tiM 
it fonrard. split ting iIm 

•boat tkt IM of aa avrrafB 

10 pffMcat ovonr* 




to f iHi rtitt t tko HaaU 



TIm **riag'' il the 
ia iatiaMU coouct with the 
poiailag dowaward aad bockwaid, and the 
aaltcior boaadaiy ol Ott riat foalitord the in/crior 
aiMiaiirir vda. After tkt Maai iaiaMiac aad a 
pan of tW daad taaMC woio lodaotd. tho riag was 
to the middW liat aad over tht loamr rmthat. 
The nng of the lac coold aot bo doaad op aa part 
of the tttOMir aad adhrfrnt jejunum cooid aot be 
radaeed. To prtvcnt recurrence of the hcnda the 
Maaaai waa aotored to the poaterior aaiface of the 
ilo«arh Joat ootaide the ifatf. toaither with a 
few aatoraa plaoad ihrouxh the anterior wall of the 
•ac aad the lotaiaed jejunum, on the left aide of the 
irda. Aa the doodtnnm waa greatly dOatcd aad 
hgrpvtrephied aa aaterior faatro-eatecoatony with 
b et wo ea the affereat aad 
of the bowd waa ouMle. Poeierior 
aot poerible b^ff aofff of 
The optning» ia the aac aad futio- 
colic Ucaawnt were sotored aad the abdoaiea doaad. 
The paiieot made a food recovery, gaiaed foa a Mrr- 
able weight, aad waa ia good health sixteen months 
alter the operaiioB. 

The potou of iateraat are the great stretchinc of 
the aac aad the d ii placid orifice down to the lioht 
liBC loan, the deaae adheafcma between th« riag 
aad the tetadaal leaii, aad the irradodble tumor. 
The a d h c a ioai evevywhera pwetnt were probably 
doe to the tobercnlooa proceia, aad Priofw thiaka 
p rod ac ed the hernia itadf . 




aad thow that are capable of 
TUa aaiy aeeai a truism, but it b aa iaa- 
portant ooe. The aothoiB have foaad that thae 
»pent in operating oo thoaa OMoa vhidi do aot 
to aatiihock BMoaani oa adadadoa to the 



eaaaaltydeariactUtioalitiaMvailad. Theyhavo 
aot aavod a«y eaoe by naUtf opfldat the abdo> 
aMa» ei p of ila a periMpa to aad oliodiagTroai a large 
veeael, "aad IkatfaM the eaaia Moriboad caaoa 



Moriboad 
are very pale, have aaMll rapid pwlaai, aad bwimi a 
picture of Mvora toteraal bleadiag; whonii la laaifcy 




they are oaaaUy eevMO 

upoa aa alimwit acgUglhle aoiooat of I 

oTwounda of large vttuU do aot raadi the airerMa 

caaualty deariag tiatliwi. Ualeaa pa titata caa be 

tided over their ibock. it b oacleia to try aay op> 

erative BMaaaiea. 

a. WabhMwfflhdpoae to decide whether actual 
peoetratioa aas occurred or aot; that b to aay. a 
patient brought in by oMNor ambolaaoe, eafonng 
iroro a wound of the andomlaal wall, will oftea con- 
plain of severe abdoodad pahi with tendcracaa aad 
rigidity in and around the musculature wooaded: 
he may even have vomited; but rest in bed will 

auickly dear up the diagnoab Agaia, wheio the 
ver, the diaphragm, and perhapa oae kidanr or 
the other have been wounded, it b very diScult 
at &rftt to be sure that there u no Icdoo of a hollow 
viacua alio prweat. Rcat ia bed briagi to light the 
progradve aya^Non ooauilci of a pcritoecd ia> 
lection: whereas the false unpresaioa of grave intra- 
abdominal injury created in the mind of the ob- 
by many casea of dmple wooada of the ab> 



Caol R. ftiwiiy aiprBiiioa« 



Wehb. C. H. S.. 



I. T. Ci TUrty- 
of foaetiillNt Wovade of dbo 
BeU, J. 5arf ., 1916, iv, 5jt. 

The aeriea roaehii of js casea, si of which were 
■abilllid to operatioa, aad 1 1 of which were aot 
opentod apoa. Tboee aot opfrated upoa fdl iato 
two groapa: (1) tboee where there waa doubt aa 

I that were aion* 
10 adadt of laparotoaqr. 
opeiatad apaa^ looovcred aad 
S died, ghdag a aMrtality of 4MSIMr cnt aad a 

worn aabarfltod to operatioa, la r ac w veiod aad g 
died, fhriag a ■oftaiiljr of 4«<Ss P« c*m aad a 
mu fO Tf rau of S7*i4 pv < 

The authors bavo 
ficulty ia deddiac wbea to opanU aad hava cobm 
to the Boadadoa that it b belter ia tvenr caee to 
wait oatfl ooe to three hours after lac el v iag the 



to tlw peaei ration, (a) tlm 
baad or too hnpdiiady aidt 
Of the caeaa aoc optratttl 



4imilnr! wall, or of the toUd viacera nnarroamaaied 
by aevere hcroorrhaae, b diepdied, aa wita each 
hour of reat in bed the patleat b cc omea oMwe aad 
more comfortable aad at eaae. 
Ia the enuaiaatioa, the (adea — pallor, aadoaa 
ainking of the eyes — b of the ut- 
■Mat help ia arriving at an ealimatioa of the 
gaaanl coaditioa of the patieat, and ia additloa. 
woiUi«of the abe aad, cowblaed with otiMr tvi- 

wheet tiM diapbnym b iavolved, b abo aaafuL 

The pobe b perliapa the OMat rdiable ndde of alL 
A aieaAy riafaig pdae b more to be rdied apoa aa a 
determinant for operation than aay other qra^Moo 
or aign. The geoerd character of the pube aat- 
oniUy b of great vdae ia deridiag whetaer or not 
aa operatioa b poadble. 

Roiplfatioaa vary aMialy with the diaMioa of the 
abdominal woaad, aad abo to ■oawerteat with the 
the BiaiociBe. Ia 




ialMdae. without 



plicatode 

fJiwdlng. 

kt aU. A wouad la vb l vi af the'diephragai 

ahallov, catchy, ■pa»aiBdlr br»alhlag at a 

d rate, oftea 40 per adaaie. Wktn there 

is much blcedii«. air hai«v h icoaiM aodcaable. 



the leepiratioaa awy aot vary from tho 
aoiBMd at aU. A wouad f 



GENERAL SURGERY — SURGERY OF THE ABDOMEN 



137 



Witk * commencing Bcritoafafa, afda. the nUe 
aokkam. and the raqMstioM beoooM luUow and 
tnoradc in type. 

Tanpenture b no guide at all in the early ttagea. 
In a great many caice, on admitrion the temperature 
b soDoormal. It b very seldom indeed that a 
temperature of over 99 degrees b ragbterod before 
the case has been tome ho«n in beo. The degree 
to which the tcmperatuie b subnormal b a guide to 
the amount of snock pmcnt. A subnormal tem- 
perature and a puUe of over 140 are grave sicns. 
If alter an hour in bed such a pube continnedto 
rise, and remained small and unsteady, and the 
temperature remained subnormal or even fell fur- 
thur, we would not attempt any operative measures. 

Vomiting as a positive sign Is useful as con- 
firmatory evidence, but its entire absence has been 
noted in cases where, either at operation or at an 
autopsv, the presence of extensive intra-abdominal 
injury has been ascertained. Patients with wounds 
of the abdominal wall not infrequently vonut, and 
those with simple bullet wounds of such viscera as 
the liver and kidney may or may not vomit. 

The escape of urine, intestinal contents, or bOe, 
or the prolapse of omentum, intestine, or (as in one 
case) liver, through some other wound, is of course 
pathognomonic. 

Tenderness and rigiditv are in nearly every case 
preeent and marked. The same remark as to lo- 
calisation made with regard to abdominal pain 
applies here also, with the reservation in both 
cases that muscular rigidity may be of more help 
than pain in localizing some cases, especially where 
a through-and-through wound from front to back 
has occurred toward the periphery of the abdomen. 
General rigidity is an important sign of some intra- 
abdominal lesion. 

Tbe authors have followed a definite detailed 
method of examination of the abdominal viscera. 
The Oeocrcal junction is sought for and the ileum 
b traced in continuity backward to the duodeno- 
jejunal flexure. The ileum and mesentery are ex- 
amined back and front during this procedure and 
eadi loop of intestine b drawn seriatim out of the 
abdomen. 

Each intestinal wound as discovered b covered in 
bv a gauxe sponge around the whole circumference 
of the ^t and held in place by a clamp. The csrcum, 
ascendmg, transverse, and descenaing csAods are 
then exaininedL medal care being necessary at the 
hepatic and nleiuc flexures. 

No remednl measures, with the exception of 
temporary hnnostasis, are commenced until the 
whole number and character of the lesions (Mesent 
have been ascertained. 

The authors believe that it b verv important to 
make a thorough attempt to find the projectile in 



every case in which it is retained. Gothlns carried 
in will be found mostly clinging to the nggbipottkm 
of shell causing the wooad. 

The peritoneum b Heantad along the tract as 
far as poasibla bgr feotle dry swabbing. Drainage 
tubes are inserted along the tract through the 
parietes. 

As to complications following operation, more 
caaes were lost from shock after operation tlun from 
aayother cause. 

There were two cases of acute dilatation of the 
stomach which reacted well to eeerine gr. i/so, 
combined with gastric lavage. 

Detention has been most marked In cases of 
wounds of the terminal ileum and of the nfmrn. 
Eserine, one-half-gr. doses of Cornel, and small 
enemata have been useful. 

Unfortunately respiratory sequeUe have been only 
too frequent, taking the form of bronchitb or a 
bronchopneumonia. 

A spreading cellulitis of the abdominal wall, 
commencing in the projectile track, b not an uncom- 
mon sequela. 

A fatal result from gas gangrene toxjemia, starting 
round a retained missile, has been responsible for 
several disappointments. 

The retroperitoneal tissues are eaafly and rapidly 
affected by organbms which happen to be im- 
planted therein. C G. Ham. 

Rtounler and I.uynier: Aoddeots Doe to Abdom- 
inal Contusions (.\ccidents des cotttusioas de 

rabdomcn). I'rtsse mid., 1916, p. 449. 

In addition to immediate grave results of abdom- 
inal contusions resulting in xnsceral rupture, etc, 
the authors point out that there are often other 
local effects which have a special sjrmptomatology. 

The symptoms consist in pain, at first sharp but 
becoming dull and persistent, in the left hypochoo- 
drial region, and a fluctuating tumor making a 
considerable projection U observed developing under 
the left costal border. 

In one case the authors approached the tumor 
by the lumbar route. On exposing the lower pole 
of the kidney they opened a large cavity containing 
1.5 liters of serosanguinous fluid. The man re- 
covered but with a fistula. In the second case, the 
transperitoneal route was used; the peritoneum waa 
healthy, the tumor lieing strictly limited in front of 
the epiploon but extending up to tbe kidney and 
enclosing serosanguinous fluid as in the first case. 
In thb case as there was a kidney lesion a urinary 
fistula formed. 

In similar cases the author thinks it best to 
use the lumbar route of approach to avoid any 
possible complicatioas doe to noo-manifest kidaqr 
ke^oos. W. A 



ijS 



INTERNATIONAL ABSTRACT OF SURGERY 



SURGERY OF THE EXTREMITIES 



TW 



msBASis or thb BoiiB&joiim musclbs. 

Ttinwitt, coRDrnqM coMMoitLT 

roimouiTBB nruMiTiBs 

VUtmm» W. D.! Aoic* OMnaqfilltfi. IV. Wut, 
Smt' Au^ 81. PmI, 1916. Dk. 

TW Milkor bdkvM Umi acou oMoaqFdillt 
btpllMd hi Um CHHBiy ol rmcnrmnr 
Tltnart two w m XM am with which thb 
ii fnqintly coofitied. rheunulbm and 
Imr. At tkt bow infcctkm usually bcfins 
la }omip Oitlk»n with ihr )io\n\. rhcumatiMi MCOOMt 
a wy Mtorml and frrqucni Mumbling block; bat 
the drvf> wainl paio alidlid by ina pfWMlO ovw 
tbe ahait, uMially MW tbe cpipbyria, ■ b a wc i ol 
igMhii ialo tbt JMM covhy. aod the sodden, 
OMM of l y o y l oo M Mff^ to djslinguiab thb 
frooi tbr arthiiidra. 

TW swcUinc and towlMMia over tW Joint are 
ptmmk aofly aod may pncode p oto to rb w alb m ; 
vWraia Joint {nvoivunent in oftcoatyaiitb appears 
only aftrr perforation has taken place. 

la the diflrrentiatton ol tlua condition from 
knd 01 bar acnio onntbenuun tbeio are 
cUnfcnl dnu to nide na bot we abould 
al«ny» W on iW lookont for bone co m plicati ons. 
rw iupbyloooccni awena b tW nwat frequent 
■foctipn, bat bndOus typboona, pneoroooo- 
and bodBnicoB conunnnb Wve been foood 
lactovk TfeamwLoinoanntocold, hsm- 
and otber devitnliiiaf lainancea are pcedia- 
poainc f acton in the productioo of tW disease. 

An interesting feature of thb paper was the sonie> 
whni novel dacription ol wWt tW author was 
nlonaad to call tW ■"^'•»***»*« ol oateomyditis. It 
danhwtth the arrest of faifection in tbe terminal 
nitoriea situated in the end ol tW bone and tbe 
■■Ibnil by wbicb quick, wide daatraction ol the 
boat and mnoonding stroctnrea followed in 
■i^tcied caaaib 
fit likened pna to steam in that it cannot W 
by prcaaure. Nomcrooa caae hiatorics 
died to Illustrate varioaa pbaaca ol tW paper. 
TW grandlatbers ol sorfefy, he said, well knew 
bow 10 save tW distal phalanx ol a patient soffering 
ol wUtlow by early freo incWoo, but Juat why 
tWy bit tW further appHcatbn ol tbb cardinal 
|ffbtT<|r'T te the treatment ol otitMnyelitb to thoae 
wW wctt to follow tbem b aifl n ayalcty. 

Rtfcioaco wat mode to tW 
fonndfeanMuntol . 
tW tmbo ibnfl ol tmnt ol tW lone booea. and ^ 
I tknt with our praaent day nnder- 
tW pnibology and imtatnt ol tW 
addUoMMtWfitwonldctttt. 
TW ^btiot, ordinarfly ipetkint. not a vcnr 
Dwit; rawgnhieo. bowover. ol tW duonk 
of oautawditb b bkMjrtmential to a dear 
lea ol ut ead-rataili following fracture ol 



tW bone, aa patienu suffering from tW cbroafc 
form ol tne dbtttt art prtnt to dmv bony ' 



ity, dtl«)rtd naloa, aoa-aak 
powtb ol boat, tad II nal 
not raoonbd tW tiuiwa b 
for wbicb W b In BO way 



van. or 01 
otanlitat trt 
blaamd for btd rmnlu 




While the name "Idbottblc 
was adopted by Lobstdn in i9jj. BItfaw iadi it to 
be unqattttonahly correct, lattmocb tt It ladfcttta 
tW pttbdogy ol tW d t ia aaa . Socb 



dvaplaaia 
plastic n 



malacta 



aBa fouii, my do 



and otberi do not dafat tW con* 
<Ution, and in fact some entirely nibripritsat tW 
actual process. 

Blaine divides the casct into tbree forma: (i) 
fcrtal oateopsathyroaia,roBmi<wly ctltdotttngi niab 
imperfecta; (a) infantile oeteopattbyroda; and (3) 
adult ostcopsathsrrosis. He reports ont ctte, and 
althott^ two others came under bb ofaacrration 
the recorda were lost. TW point ol intermt In 
the ^^nr»**«*« ol thb condition b tW tbinning ol 
the shaiu ol tW long bonct where tW araluplt 
fractures usually occur; tW heavier booea and tW 
ends of the long bonea are not likely to be involved 

W. S. .\i 



MInilon G. H.: Bscmidaii infectloaa of Jotett 
In Acute Medical AUmoata. BrU. M. J., 1916. 
ii. 289- 

Ediivtoa nporu three caam: oat ol 
paeomooia c om p l i cated by a pn tM moro cc 
ol the knee; one of empyeam (pneomooood) with 
coxitu (»trrptococd); and one of cerebroqtinal 
fever with suppuratioo in the knee-joint. 

TW author bdievcs that the lowering of aeneral 
retbttnce plavs a part in tW occurrence of ioint 
involvement (n tW courw of medical coadltJoaa, 
but W b unable to explain why ccrtaia Joinu are 
involved, as in none ol tW tbree caaea riporttd wat 
there any k>cal cause, a straaam, dlMovcred. TW 
probabilities are tWt in asoat caact ol tacoadary 
artbritb tW coadltion b to W looked apon aa a 
metastatic one. F. D. Doaow. 

BniMT. P.t A GOae of Arthrono ol tW Vaatoa la- 
nriMaMaade (Ela FaU voo Arthrwaa la Modfid 
vastus faueraus). Tr. XI Smth. Stmt. CfOf.. 
;. 1916. Jdy. 



leal 



TW tatWr deacribea n aptdmen ol tumor eitir. 
ptted from tW vnttat {attnam aawle tad iu tta- 
SobT From tW cHofcal tyavtoom tad tW taaiom. 

of the tumor — lu form, locttloa, lit 

ting upoo tW ptteUa, tl 

waa taiptcttd tbtt it 



GENERAL SURGERY —SURGERY OF THE EXTREMITIES 



139 



FlodcnM. The nkrotooBk etinrfiunion of the 
tumor corroborated this view. 

A gnN4» ol tamon formerly known under various 
DUMt (gamHnns, tyBOviaJ ga» f ** «M » tynovial 
cyttomaU) are, according to Flodenia, histoid 
tumors <d joints, and be gives thrm the name 
anhromata to correspond to chondromata for his- 
toid tumors o( cartilage. L. A. Jtrsxu. 

FRACTUUtS AND DI8LOCATI01I8 

\ C O.! Obseriatluii 00 Practuraa. S. Y. 

5t /. Mt^., igi6. xvi. 466. 

The author's observations are baaed on 1 16 cases. 
He states that every fracture b potentially a deform- 
ity and if it becomes a pcrmanrnt drformity it will 
lead to impairment ol (unctiun. The object of 
treatment b the restoration of complete function 
and the overcoming of the deformity with the 
least risk and inconvrnirnce to the patient and 
the least anxiety to the surgeon. The author holds 
that the smooth working of a limb depends on 
preserving the true axb of the movements of the 
joints, so that the stress of muscular action may 
act acrosa the joints in normal lines. Therefore 
in dealing with fractures of the shafts of long bones 
the first consideration b to secure and maintain a 
true anatomic alignment of the bones. 

Barney states that surgeons with large experi- 
ence in the manipulative methods of treating de- 
formity will obtain better results than the no\'ice 
and these surgeons will reserve the operative methods 
for those cases which show that after skillful manipu- 
lation they were unable to retain the parts in a 
correct position until union of the fragments had 
taken place. 

The old traditional wooden board used as a splint 
b fast being abandoned. No human limb will fit 
a flat board. If the limb U bandaged tight enough 
to maintain immobility of the limb on a tiat board 
splint the pressure will almost certainly cause 
pressure atrophy of the muscles. A joint that b 
tender to palpation b not ready for movement. 

In the sccmid part of the paper which b devoted 
to a consideration of special fractures the author 
mentions the tise of thyroid extract as an aid to cal- 
lus formation. For Colles' fracture the author 
insists on the use of anesthesia. When reduction 
b complete no partictdar form of splint b insisted 
on. lie has no fear of a stiff wrist where there b no 
injudicious pasaive motion applied. Other fracture 
treatments mentioned are along conventional con- 
servative lines. IstooBc Coax. 

Owaa^W. B.: Intra-artfcular Fractures. tmUmat. 
J. Surg.. 1916, xxix, 31J. 

The author presents an interesting and instructive 
article on intra-artiadar fractures. He states that 
solutions of osseous continuity involving intra- 
articular surfaces, having been recently encountered 
with comparative frequency, imluccs the conclusion 
that many such lesions were formerly overlooked. 



Radiographic examination prior to attempted 
reduaion b necessary to daunnine the extent and 
character of the existing laafam, and afterward to 
demonstrate whether the proper approiimation of 
the fragments has been obtained, and the likelihood 
o( their renuining in fixed poaition until union 
occurs. 

Intra-articular fractures are siwceptible cl the 
sane division and classification as ioititions ci oe> 
seotis continuity elsewhere, vu., (1) rimple. (2) 
compound, (j) comminuted, and (4) accompanied 
by varying degrees of luxation. In the order of 
their frequency the occurrence of such fractures 
may be approximately stated as: (i) at the elbow, 
(j) the ankle, (3) the wrbt, (4) the hip, (5) the 
shoulder, and (6) the knee. 

External traumatic lesions coiutitute the prin- 
cipal causative factors, such as crushing or twbting 
of the wrbt. elbow, and ankle; less frequently of the 
knee, hip. and shoulder; gunshot wountb may also 
be instrumental in the production of typical com- 
minuted intra-articular fractures. 

.\s in the surgical management of fractures in 
other situations, the primary and essentbl pre- 
requbites to ultimate successful restdts are: (1) 
the avoidance of infection, (2) the accurate approxi- 
mation and maintenance of the fragments, and (j) 
the prevention of disabling deformity. 

All simple intraarticular fractures which can be 
effectively reduced and the fragments w^Mainfd in 
correct anatomic apposition with fair prospec t s of 
future unimpaired function, should be treated by the 
closed mctho<l supplemented by external application 
of proper supporting devices. 

In the majority of fractures at the elbow-joint, 
placing the arm in extreme flexion has proved satis- 
factory. An exception to thb must be made in 
lesions of the olecranon process, the best result in 
that type being obtained by fixing the arm in full 
extension. 

In the hip- and shoulder-joints, if fracture occurs 
below insertion of the deltoid or psoas muscle, the 
limb may be dressed in abduction, which will favor 
coaptation and maintenance of the fragments. 

Fractures occurring about the wrbt and ankle 
should be so dressed as to best maintain the frag- 
ments in accurate anatomic approximation. 

When fracture implicates the knee-joint the most 
favorable result may be secured by dressing the leg 
in moderate extension. 

In compound and the majority of comminuted 
intra-articular fractures, where the fragments can- 
not be maintained in accurate anatomic appoaition, 
the open method must be employed if rcstoratioo of 
function b to be expected. 

Drainage should be practiced in every compound 
fracture which invades the joint. As a precaatlon- 
ary measure, in anticipation that infection by the 
bacillus tetani mav nave occurred, the patient 
should receive an immunixing dose of antitetanic 
serum. 

In extensively comminuted intra-articular frac- 



I40 



INTBRNATIONAL ABSTKACT OF SURGERY 



is 



bil 



ttarilatlM «f 



la tbt Mat ■Mtlhr oMUft tkt «illBuu pcodnctioo 
of pafftlil Of conpnlo oaltyloriii tbt Uab ftoMiiiini 
pnctkoVjr iatd b tlw pomoiiiii vhkb li it plocw 
dnniMpi ofo opoUod* 8ono 
I ■obBtjr MMJ fonctloool la* 
bt oip o ctoil li ibt majority of com- 
MuriMltd iMnkMtJailar fnctoiw, 
uid tlw potfat ibMid bt to itfonBod btfoco treti- 
■MM It Midtrtakatt. 

la tilftralbn tbt opta aMtbod of tiettlag ioira* 
ailkabr faacsaitt, tat jamotttart of OMtt risid 
tatiNk pwcaatiwit it tftla tmnbttlttil If the 
taffoaaAaa be Mich m to pwc la dt tbt ttttinnirnt 
of tMt dtMttBium. the opoa mtcbod tboold aot 
bt taipltycd; it b vbrr to tnitt tbt tdllnute out> 
etaw to aaturr with the dottd awtbod, than to* 
tabltct tbt PttittH to nifwfft i<TT*f** Jafc ri hMi tad 
tbt ctattqatat additiootl dai^Mt to Hit. 

la tbt Bfodactita of ftf**** of Joiat foacntatt 
abtorbabit 



tt w ic tui tt, tad to 

atnrt topply to f tr tt bmjt bt . 

6. Dttpitt tbt Itvortbit rttiiitt wptfttd by otbtr 
largtoat fftai tbt tp|ilicatioB of aoa tbttrbtbit 
MiUianctt to Aliag tbt fnnnwatt to iatra-aitkator 
fftciitftti it it bt H tvtd fatvft tiptritMt wfll 



tbtt tbtofbtbit iMUttitl It parftnblt. 



RalaakJnt. II. i Gootral GoatMonicloo la iho 
TrtatBMOc of Fracturtt. Wh if. /.« 1916. sv, 
US- 

Krinrkinf bclievr* that hy early TftTlflTl of 
fracture*, there b let* •weUing, Icat 



tad totttiockJM, Ittt iattcpotteloa of otatf tittat* 
tad Ittt ptoltaatd tojaiy to atnrtt tad btood- 
Ytttdt. Antthwlt tad X-rty tiamtotfloa tboald 



CmiSm 
tact far 



Mat ■aitnai ■ atntfaa pmtreoit. doc |ooa 
bava btta itpoittd lioai tbt tpnucttioa of 
tdwtk trirat* tad atflt for tlut pnrpote. 



dtim fa 



r tait porpote. 
a dtddtd picfer* 

hofy or booe 
rctaltt have been 



Tbt tfltMitttaMBt of intra-articular fracttue 
to ttaM fMptctt from that tpplictble to 
of oattoat coatiaaity to otbtr titatlioat. 
Hot tpplkatioat aad Ufb^ aaaittft auqr bt ad* 
italtmnntljr tavtoytd ttlHtr. bat ptarive motion 
tboald aot btttttontad aatl tboot the fourth week, 
tad evta tbta tboald be practiced with caution. 
Tbe coadaitoat tic: 

t. Tbt tantta tboald bt aOotrtd aamie time for 
tbofoogb HMV of etcb iatsasutkaltr fracture be- 
fore ill I iiMat opoa tbt tMtbod of treatment ; there 
it ao aatd ftr btttt to tppHftlion of the permanent 
_ Bor to dtditoa fw a rtratog operation; "the 
fcBCtaia wH bt pnttot a ootk later." 
a. Aocarttt tattoarir t a pw rimttjoa of the 
fniffBMatt b aMMt ttttatltl m fctctarat tovolving 
Mat ttfoctant tbta tbott to otbtr litattioiw to 
lataia fataio itttortttoa of faactioa tad |otot 



bt tbt rait to all frtctaict. nttltr ctau art prob> 
ably tbt bttt itttatho tpplitace« but to mmm 
lattaocet lattetd of tbt dicnltr cttta, tbe OMldtd 
platter »r>lint may be aatd or biidaiag ovor of titta- 
thre tojury by iroa btrt inbtddtd dltuOy tad 
proiinMtty to platter. Compllcaiing injunct to 
vctteb and aenrct tboald be toaght for. Paadve 
motion tboald aot be practiced fa Jofat fractorca 
until firm unioo hat been etttblithcd and acute 
•enaitiveneaa diaappeart, for tbe ultimate mobOity 
of a fractured Jofat m determined more by the extent 
of fajury incurred by tbe Jofat itructurea and by 
the accuracy of the repotition and fixation of the 
frafroentj than by efforts at re-«atabliabing motloo. 
The active exercise by the patient after firm aaloa 
b the one eaaential requirement for the reatoratioa 
of Bormal function. R. G. Packabo. 




J. Tit t M lbnri of treataieat cuia loyad tbooM be 
tbe oat aritb vbkb tbt tafftta it tbaroagbly ftaill- 
itr, tad vbkb bat btta piodactivt of tbt moot 
aad fnactioatl ratoltt fa bit 




Grant, H. H.: The Opoo Tr— t n aaat of fta mo ea 
by a Sfaaplo Devloa. Tr. ShoM. Smg. tr Gytm, 
Att., ^1iiu Sttlpbor Sprii^s, 1916, Dec 

The author briefly ditcattat tbe Jndicatloat for 
the open operation fa certafa fncturea and orfet 
the foUowinf atept: When in recent fracturea of 
the femur, humerua, or tibia, the X-ray ahowa 
approximation to be unalJowabiy imperfect, alao 
fa ail ununited fractures or in all caact of vidoua 
union, the scat of the fracture aboold be eipoted, 
the frtfmenit tdjotttd tad fixttioa tftcted. Tbe 
qwdtl device rtooouatadtd contittt of ffadeta. 
with a tcrew thtft, ated either at one or two ptltt. 
The ahafu are acrewed fato a drilled bole fa tbt 
bone, just abovt tad below tbe pofat of teptrttioa, 
after the a ppmi i ai atloa btt btta mtdt tbioagb 
an open woaad. Tbt btadltt of tbt glailtla, 
which tre itt, tre broagbt tofttbtr aad ttcaiad by 
t tbiuabtcrtw wbicb boldt firmly. If two pain art 
aatd t pittltr cttt It aot attdtd. Uliea oaly one 
pair ttta« aaAdtat t Ugbt cttt b tpplitd tfttr 
tbt voaad it dtttd tboat tbt tbtf ta. Tbt cbuapt 
tia ittatwd tfter aisteea to tweaty dtya. Tbm 
It ao lattoa to fttr fiw f tTlLy ** tloi^ tat thai l Elibt 
cttet trt rtpofttd witboat faflaft lo 

Graat btttavtt tbt fc d to a hn < 
tound taiftiy: 



GENERAL SURGERY — SURGERY OF THE tLXTREMITIES 



MI 



I. The ftdv&BUfe of directins the adjtutmeat 
aad fiiation of the frafmenu in mott fractures of 
the tbi^ and the humeral shaft, as well as of the 
tibia and other long booes, under the eye is often 
•o positive as to raonife only a safe and simple 
Method for feMial adoption. 

s. Badly opposed, as well as ununited frac- 
tures, oooditions readily saoogniaed by modem 
fadUtiss, demand onddayed treatment by the 
plan. 
'5. The application of abeorbable ligatures 
l e qulf ss as mndi or more manipulation as dses the 
pottinf In of plates, with far less security, hence 
the mk b not compensated for; and wirinjg of tlie 
fragments gives poor fixation, with the drawback 
of a retained foreign body. 

4. While the Lane plates in skilled hands 
accomplish perhaps the best fixation, the method 
carries with it the serious objection of the danger 
of infection, and even where all seems to go well, 
later removal b often required. 

5. If by a simple, inexpensive, and safe method 
of fixation, not even involving the broken surfaces, 
approximation can be maintained, open treat- 
ment shoold become the ideal method. 

D.: Some Aspects of the Treatment of 

Practuree Under QtU and MUltary 

BmIm M. tr S. J., 1916. cUzv, 44a. 

The author bdievcs much good will come from 
the knowledge gained by surgeons of the warring 
ni!H*ft* The care of wounds in civil and military 
fields b discussed in a general way. The author 
docs not believe that internal fixation by means of 
booe-plates, etc., in infected wounds of compound 
fractures are contra-indicated. The varying effects 
of projectiles at different speeds together with 
dotning and soil contaminations are discussed. 
Hypochkiroiis add has been used with good results 
and b especially recommended because of its harm- 
lemness, it having been given intravenously. Dur- 
ing acute infections the use of plaster of Paris b 
not recommended, the author preferring splints, 
etc iL W. METxaooio. 

Dnriach. W. : The Importance of Earlj Rednctioa 
of Fractures with Plsplacsmsnt. 5m<m. if. 

ir S. J., 1916, cUxv, 437. 

The author makes a strong plea for early reduction 
' ares, believing that fractures should be dass- 
' (oergencies just as much as ruptured ulcer 
and acute appendidtis. Further, the A-ray plant, 
an indispensaole aid, should be ever ready day or 
night. Sundays, and holidays. He believes many 
of the open operations could be avoided if proper 
attempts were made the dav of the fracture. 

Hb conclurions are as follows: 

I. A more exact replacement can be accomplished 
in the first few hounthan if the redaction beddqred, 
especially if that delay be a matter of davs. 

a. The percentage of perfect anatomical results 
will be much higher with early reductioiL 



3. The ease of redoction will to a laife extent 
vary InvecMly with the time el^pdng since the 
injury. 

4. The additional trauma caused by —"^puTv 
tions during reduction will be redooed. 

5. The evil effects of pressure of a dbplaced frag- 
tauA on adjacent structures will depend on the 
duration, as well as the amount of tnat prcsmiii, 

6. With a more perfect redaction comes a de- 
crease in the amount of new tissue necessary to re- 
pair the injury, which means a lessening of the period 
of disability and a more complete return of foncUon. 

7. Lastly, the amount oif pain and discomfort 
subsequent to the reduction wul be lessened. 

H. W. If Evnoom. 

Dyaa, P. G.: Treatment of Fracture bv Nail Estco- 
shm. Swt.,Gyn€C. frOhtt.. 1916, utti. 478. 

The method u a compromise between the fre- 
quently inefiident closed method and the *»ifar4ffiis 
open operation and was proposed bv Steinmaan, 
who got his idea from the MaJgaigne books. Stein- 
mann's explanation of the method b that it exerts 
a continuous traction exdusively by the aid of nails 
or screws which are driven dthcr in or through the 
bone, whenever possible through the lower frag- 
ment. Various modifications of nails and screws 
together with methods for introdudng them have 
been used, but the simple steel wire nail driven 
through the bone by a mallet is as good as any. 
Careful asepsis is, of course, necessary. The 
originator of the method treated a number of hb 
cases by local anesthesia. Thb was not attempted 
in the author's work. The nail may be used both 
for traction and as a lever when rotation has 
occurred. On account of the great traction exerted 
it b necessary to have frequent X-ray examinations 
lest a separation of the fragments take place. 
The optimum time for leaving the nail in sUu b 
ei^teen to twenty-one days. Traction applied 
for a longer period may cause the nail to cut thio^k 
the bone by means of a pressure necrosis. 1^ 
advantages of the method are: 

I. It b less dangerous than the radical open 
operation. 

3. It enables the surgeon to exert the "»*»*—— 
amount of traction while using the mininram area 
for the attachment of the traaion apparatus. 

3. It will bring about a reduction of the deformity 
in old standing cases where other methods fail. 

4. The technique b not difficult and can be 
mastered easily. Therefore, the method b practical 
and can be used by the entire profession. 

5. It gives access to wounds in compound frac- 
tures, permits of frequent dressings, and docs away 
with undean and infectious fixation apparatus. 



doufth. F. K. : Fractnras of the Leg: Ead-I 
in (>nr Hundred CooeecMtlye Gases. J. 
1910, uutvi, 509. 

The report b based on dough's experience in 
mining dbtiict. The sges in 7s per cent of the cm 



>4« 



INTBRNATIONAL ABSTRACT OP SURGERY 



«tft bitwmi to ««i 40 yvan old. Tbt avtrafi 
MM 9i diMbttiy lor al caM «m qI 6 days. 
CoMOTvaihr* ■■taoJi wn9 l olowid m far m 
poMibtr la haadtiag Um cmm. (My 4 ptr cmm 
«rfr ofirr«irtl upon for ibo ftoctttft alooc Sont 
a( ihr c<Mii|M«id IffoctorM whkh won iaiocird 
ttttiird whilt lymiui WW r«tn« 00. and Oougli 
k unyfv of tkt opbdoo thai i( rrpoolod ofloru 
art aoot ibt Majortey of locvni (r«cturca of tht lag 
raa bo p«t iaio ttat aad held thort Inr cooMrra- 
tiw iufcodi. Ho b alM of tiM opiMoa Umi it 
rrquiioa aa aaKk onoffanco aad ovca omno at- 
iroiioa to daiafli la laadk (racttttw by tbt coa* 
•crrativo BMlbod aa w(ib tioataMat by Ibt opea 



• C» tMt 



Haallagloa Matr* that tbt auilority o( dcUyod 
aaloaa aw dat to faulty baadttaf of reccol fractaroa. 
Tbt BuJnrity of ibr autbor't caaaa wtrt lodaotd 

bavt loianwd to tbt aaaw lypt of work tbty 
in Mior to tbt btjanr. TMaaoa bM 
aoiod aa a rwaidiralinn of (ractum 
la ovar joyooo accidral caaaa Ifoatcd by the author. 
Ho tbambra doaa aot aaa atrom aa a propbylactk 

laiDoas Ci?a if i 



G. T.x Tlaamiim of Practuroa of cho 
fapiHaHy la cho Old. Tr. S^mtk, Smg. 
trCjmt*. A$i . While Sulphur Spfii«». 1916. Dae 

Vaagbaa bcUevct that the moat '^"^""m caaaa 
of dcatb after fracture of the femur ia Ibrooiboab 
with CBi^eiiHa — cither from btood<lot or from 
fat. 

He doe* aot brtirve in operating oa ever^ caae 
of fracture of the femur nor in putting Uirrign 
tofial ia tbt limiii wiMa operatioo ia performed, 
eanry. For aedi fracturca. with 
jood jfir t4lf im . plaalar of Paris ia 
appiad vitb tbt liai£ fai aoraml olcatioo: with 
OHBlBGaaMat of fragmenta. llliitman't eitrrme 
ab da ctt ea aad piaster. If thia treatment faiU to 
oCtct lodactloa opea oprraltoa aad tne of a acrev 
or otbt r awaaa iboald be cnaaidered. 

For aball fmctorea. when Buck'* and other meth- 
ods of otfoaaioa are aot indicated and open opera- 
lioa la dacidad apoa, acvcral aietboda auy be uaed; 
piafaiabli oipooaio of tbt fragawatt and their 
caaplalloa ia aacb a way aa to aiaiatain their 
MaUoa afaaoly by aa cxioraal ^diat. In oblioue 
bactarca tUa caa bo deaa by the intertocfciac 
■Mlbod. tbat ia. faMffdaf oat of the aharp tadid 
fragawau iato the BMdalafy cavity of tbt oibtr; 
ia traaavoat fracturaa. by aa Jattaiaodiillary apl^ 
lakta ffoai ibo fractaiad ooae. 

If aecanary to aat airtal. ibo platca aad baada 
aia pnfcnod to wire, aaHa. aad acrtwa: for timaa- 

tbtoiaalbaadiof Parbaaiaad Manin. Nowcigbt 

bo bocao apoa a ftmur «hicb baa boea 

for foar awaibai aad good faactioaal 

( bt wpariod aoaaar ibaa afai to 



twfo of llM 
cbiv. 441. 



r. R. H.I Oartaia Pacta 
oattMac of Prac- 

M. tr S J . i«ia. 



The 



author raporu the reauha of oparalivt 
tnaiiaaai at tht M««achu«nt« (General mMpital 
in tba tlMtflWOt of fracture of the patella. 

Opaa oporaUoo. »uiurr with alMorbabIa aulartal, 
l a wabfl i MHi ea for a few «erka. the patital wi 
with kaaa faad, aad catty active BMtioa aad 

Ha baHavm ibt aoa-optraiivt oMCbods iwdl ia 
oaioaa aaioa bacaaat of lack of botqr toaiact 
cbbofttaiaipoarfbla. 
Eigbty-oat par caal of caaaa have dtaMaatrattd 
boay aaioa, aad 19 par caat have failed to grt boay 



TUrty-cigbt caaaa wore followed: 04 ptr coat bad 
full exteaaioa al tbt bate; 60.5 per coal bad full 
fkiioa; $7 per cent had full extenaioo aad fkiioa; 
6^ per coat coald work as well aa before fractore. 
Twenty-two caaes were X-rayed: 81 per oeat bad 
bony union — 18 ptr coat fay bridge of boat; 18 
per rent had no boay unioa. Good rtaalls wart 
found in thoae having noo-onioo. 

In the icrica, 39.5 per cent bad liadtad fkiloa. 
The author bdkrvca that ia order to iaipfovo tbt 
results of operative treatment of fraciaiaa of tba 
pateDa, more accurate reduction b aaaded aad aa 
rnrirrling auture of abaorbable material, aoch aa 
kaagaroo tendon, b a moat satisfactory aid. 

H. W. McTsaMMo. 

SURGERY OP THB BOlfBS, JOIIITS, ETC 



Lcriche. R.: Reosoval of Subparloocoal Boao PTi^- 
moQCa In the Prlasory Traatmeor of Artfiory 
Wounda (L'taquillactoada ■oua-pMoalle brpK 
priouti%-e daaa h trakaaMal dcs fractwoa par pr»> 
)ertlle» d'artlUarb). fnnt mt4i., 1916. p, 40s. 

Lcriche sasrs tbat the rapid and large bospital 
dearaaces during reccat OMatba have abowa Iba 
good cffocia of priamry nratoauuic oaigical iatar- 
vcatloa b fractures cauaaa by mnSBimf pwijarl ilea . 
As a general rule the iatcrvcntloaa amda fanatriy 



general 

aot safbckaily irtaaaieii aad 
exteasivt iafactioa BMifcad tba tvolutioa of 
in spitt of tbt applicatioa of antiatptici, ate Tba 
necesaity of aacb latorvoatioa awv ot gaapri from 
tba faa tbat fai la diap h y aary iracturm locaatly 
recaivod, radioaapby aaowod bone fragoMats ia 
coaaa of aticroab m i4t aad fai 11 of tba 
ialMveatioa waa aaoassarv to reaMnre tba ln_ 
Wbia Lecicbt dota aot doubt but tbat fai aoam of 
tbaaa caaaa a appa ra tioa would bavt slowly aa cca ad td 
ia ^f^w^g CMtaia of the fragmeats aad tbat tbt 
fractarm woald bave ultimateTy coa ao Uda l o d witb* 
oat reHipaiatioa, yet be b quite sure that the 
rcaahiag caDaa wawd bavt baiea oatailic, taife or 
painful He bdbvoa tbat tbt faltal wfaicb abaaM ba 
sotti^t in war lurfery b not aitrely coaaoHdatka, 
bat aaeptic caaaoMdalioB. aad tbat a palbolagic 



GENERAL SURGERY — SURGERY OF THE EXTREMITIES 



MJ 



calha b in general bnd and ihoald not be allowed 
to fonn. 

Letkbe thinks that in artfllery fracturea earty 
inlMi— lluii should be by rigoco m and complete 
•iqpllecUMny. Bv thk tens ia meant the complete 
ramofral ol all frafmeata of bone, etc.. in the 
f rac tof ed area. The complete procedure rccoro- 
mea ded by OUier which involve* the total perioa- 
teoaaadaoc the fibrous perioateum alone should be 
foOofwcd. After mch wide iatarvMtkm and with- 
out anr antieeptic the wound b feneraOy observed 
to evolve asepUcallv. partioiUriy when the dear- 
anoa b asade immedbtdy after iniury or very soon 
after the frst ephe m eral snpporation. In such case 
if ammratioQ still persists it shows that there is 
inilltfclBt jret to be eliminated and further radio- 
grapUc research b called for. Moreover, with such 
a pvooedore the callus formation b quhe normal 
and aseptically buflt up of healthy osteocenetic 
elements unaffected by any procem of infection. 
Necessary surgical cacpiiUcctomy b therefore also 
phytiologicallv permisaihle. Allien such b done 
widely and full^ in the subperiosteal manner pre- 
scribed by OUier, the healthy periosteum rapidly 
effects the reparations called for. 

Leriche therefore concludes that wide esquillec- 
tomy should be done in all fractures due to artillery 
projectiles in order to constantly assure an imme- 
diately aseptic evolution of the injured region; that 
is, bpr an aseptic reparation of the solution of con- 
tinmtv whicn b the primordial interest of the 
wovaded man. Besides it removes the unjustifiable 
laar of paeudo-arthrosis, and subacute and chronic 
OU dt e a , which give a gloomy prognosb in cases of 
insufficiently operated fractures. W. A. ButsyiKs. 

Srhmiadan, V.: Boo* Suture la Granulatini 
WmhmIb (Die RDocbennaht in KranuBrrender 
Woade). Ztmlnthl.f. Ckir., 1916, No. 39. 779. 

The author discusses injured and infected joints 
and injured and infected bones of the lower extrem- 
ity which on account of the infection have large 
granulating areas and in which union of the bony 
parts cannot take place. Rather than wait for 
the part to heal completely, until all sinuses have 
healed and a pseudarthrosb has developed where 
weight -bearing b necessary, a procedure whkh 
with the ordinary osetbod of treatment with casta, 
splints, scraping of sinnses. etc.. will take many 
months, the author advises that bone suture in 
panulating wounds be done as soon as the patient 
IS free from fever and the wound i* clean. Irrespec- 
tivc of the amount of secretion the wound b laid 
open under lumbar aiursthesia. the Iwne encb are 
freed of the soft parts without much damage to 
them, and the sranulatlng ends of the bone are cut 
away clean with a saw so that two freah surfaces 
of healthy bone are approximated. The ends of the 
bone are then perforated through the granulations 
and stout bronxe wire b used to bring the bony 
surfaces together. The limb b encased in a fenes- 
trated cast aad the wound treated open or with a 



few l oose ly applied pieces of ganae to Insure removal 
of tecreUoB. Ia six to eight weeks the bony uaioa 
ttsoally b so firm that a second or the last cast 
can be applied. The wire* are removed through 
the window of the cast about the fifth or sixth wtSL 

The operation prodacea excellent resalta ewaltf 
a few sequestra have to be removed at the time of 
the operation, or sinuses have to be drained by 
ooaateriadaioaa. These do not hinder the bony 
tiaioa aad the eatire time of healing is shortened by 
manv months and capecblly the long waiting for 
all sinuses to heal and before an aseptic boae suture 
can be undertaken. 

The advantages of the method lie undoubtedly 
in the rapidity with which healing occurs, in the 
certainty of ultimate cure as *g«»i«ft a disadvantage 
of a slight shortening which can be corrected with a 
high-sole apparatus. L. A. Jinoru. 

Broca. A.: Some Principles in the Proatbedcs of 
the Lower Ua&b (Oudques priacipcs pour la 
protb^ du aseaahre laferieur). Pntu wui.. 1916. 
P 389 

In the manufacture of artificial legs the author 
thinks that the .\merican method of fitting the 
stump in a hollowed cone of wood b very much 
superior to the older methods of leather cone with 
metallic armatures. Contrary to the opinion of 
' American orthopedbts, however, he doea not think 
that the tangential contact of the cutaneous surface 
with the hollow cone gives a support of any great 
value. It docs not give support to the weight ^ the 
body at the points of application where so^ support 
b necessary. In the case of a thigh ampotatioa the 
ischium b the point where support ojf the body 
weight U needed, and in a leg amputation thie 
support b needed at the tibial plateau. 

\ further point referred to by Broca b that 
American manufacturers have been unanimous in 
decUring with Drpage of Brusseb that a leg ampu- 
tation is superior from the prosthetic and function- 
ing point of \iew to any kind of a partial foot ampu- 
tation. Such stumps never give satbfaction and 
the patients do not walk so well as if the limba 
had been amputated 4 or 5 cm. above the tibiotarsal 
articulation. Broca b of the opinion that certain 
partial amputations of the foot are compatible with 
excellent prosthesis. Such procedures have only 
one drawback, which perhaps i*^ptains the auuni- 
facturers' position, that apparatoa of this daaa are 
diflkult to make. 

Chopart's amputation has one grave defect, the 
anterior muscles have not suflMent leverage so that 
the patient walks not upon the lower face of the 
calcaneum and on the plantar surface, but on the 
head of the astragalus and the calcaneum. How- 
ever, if precautions are taken, thb i a conve ni eace 
may be obviated and it b an caagfua tioa to say 



that Chopart's amputation never ghrca aay hot 
poor resalta. Some of the resalta obtained by the 
author aad other surfeoos with Chopart's ampota- 
ttoas have been very good. W. A. BaamtAx. 



INTBRNATIONAL ABSTRACT OF SURGKRY 



r.J.CA.1 >!■■ ■■iirtii laf>Mf <mw 
Ki iff ti H y. /. dm, M, Am., 191ft, hvi, 

u fiKMnft of iIm low 
mmOm bgr piMior coii. 
hf Bwckli ■■!— ino h 

■il ■■twilno, o irtlwd iii wMcJi boojIiimm tioc» 
tioo b onHid lo tW oadi of Moil Mi tiow- 
faiof iko MMV or UMo fai Um j oww finflMBt« or 
tiMOicildo. TMiMBvasalbiiod torHMiaato 
f gf oltlii 10 lUi^Mbo &tjf. NoB 
il h^'fntr ' fai Um foioviM cowtlilnM 
ictvn witk oiui ii l fo akiMiott, 
fiKt iiff villi oMicii dmiiinhjn 

of tofl pofb, OMltlBlt iokniM to Um mom limb. 
Itactono of trroiol vow Hiadim viUi omdi 
oad old MohnioB viUi 



tfoctlMi of Um toft pom. 

TIm obJo cU ooi of poio oad inlocUoo hovo been 

omIh ofldMt Um MiUMd. Polo b oUaiaotod il 



tfct •»• of Um he or tWgh it poOod upvord, vkOe 
tko ool b iMtnod. In fi ffli ifw vfll bo obooat if 
•ttict aacprft b obivvod, oad if core b ukon to 
koip tbo iitt of ImhUdo away tnm Um fnctwo 
OMfTOv covity. |oiot cavity, or cpipby- 

J.t loitr Trail 

~ ViCll 



Bonpoctib J*t loH^ IVm 
BacMdag Thooo vie 
ambmmm mioom 6m 




(BMML 4 ittOCp* 

ooo dn icbtnnolt ohmb). Lym iklr., 1916, 

la kace-joiot war tnuunatJsaM Botqoette treats 
i^laiiea of ibc ciil-<ie-«oc by rimple artbrotooiy 
Where ilMre b peart ration of the joiot, 
L bo otractod aad Ibe anicolatory 
la each caoaa vide reecctiooe are 



lie tbinka that ia ImJiiukB of the kocc- 
Joiat vitboat OMooaa dartiacUoo or without 
of the aplphyeea aa eariy inter- 
taiiily MO wii the d> vilopiaeiat of 
aiUalUa aa vol aa aratHatinc operatioaa, 



vUch aoaaaliMaa loealt ia poor faacUoa later 00. 

laladoaof the aabiflripital caldaaac aeaerally 
yiald to afthrocoaqr of tho caldoaoc. Siaifbal 



ii^iafica vith or viUwat 

cal for aiavio OMah drataafe of Um artlcalatioa 

vith a aaooadary aftwotooBy oaly ia caae of 

W* A. BaaniAsi. 



L.I TholVMMMHBCof KaoolalariaaatdM 

II (UiiiiiiBiiatdeiDlaieadofooiravt). 
If ■«■. Sm. 44 cMr. 40 ^«r., 1916. itt, 1964. 

Ia iha oady pan of tho var the tioauacai of 
MO-Joial iMnaa gave tho moit iinaaiirfaflwj! 
nrfia aad caaiad MKh doabt ao to Iha oOcaqr of 
Um aMdaa of uooiaiiat ihaa pracUoad. Jhab^ 
Um im vear each iaiariaa von bdaf fwqaeally 
f elaaed by a oppa ra tioa, aiapatatina, aad daoih; 
b«l daUag Um pool year ihoia fMaha an ao loafer 
obeervod. The ndical chaaat b dae 10 the honor 



h a avlodge aov citaat of tho analony aad poiho- 
loiic phyiioloor of var ialatioa of Um kaoe; aad abo 
^tk ^ ^ptlltT i tp iTf tTi atfMi flf the In d if a l ioai and aeodo 



Tha taialii of eipwiiBPi to ihb dan of l^Jatlaa 
b aannod m bgr Saacan ta foOova: 

I. PaaeUfana voaada by bollau or 
of ahaB ahoald ho tnaiod by oparativa 
Mipib of tho odice, aad by inawi 
kaee to a rlatlif apparaiaa* 
t. Mcdiom arade or eaieaalw l^laiin by 



!Z. 



gnaadcu. rtc. ftbould be operotod woa laaai 
by a ftkillf ul ftuncoo altar nkBogvaplnr of 091 

3. II foreifn iMxileaanradiograpeically nvoalad 
to the nfighborJMod of tha voancL they ahoald be 
r eawvod 1^ lateral arthrotomy, foOoved or aot by 
ayaovial sotare. Wheo the prolectile or other lor> 
aiga body b at a distance from the entry ociin and 
embedded in soom part of the Mnt an esploralory 
arthrotomy should be done, but can ahoald be 
taken not to allow drainafe into the knee. 

4. If bonv inira-^rticalar leeioaa an revoalad| 
dther clinically or radiofraphlcally, priaury typical 
fdaorolibial rencUoa b ladbatod. 

Seacen and hb ooOaafan have p arfbr a n d 10 
lateral arthrotomica for peaetrating kaee tojnrin 
vith intra-articular projectHea. Then vcn 9 per- 
fect recovcrin; 000 vaa oaaaomafaL 

Of ft wide exploratory aiUutnomies vUch ven 
performed, succcm was obtained in all, onloa beiag 
by fint intention. 

In 16 primary resedioaa of. the kaee perfonaed by 
Sencen during 1915-1916, 14 cases ven aaonesful; 
one aa^Mtatioo of the thigh vaa 1 
patieot died. W. A. 

Duraan, F«t OrdMaMrphic Raaectloa of dw I 
Ardcntodoa (Reeesboe ottworfcoc ddt'artico- 
ladooe dd geaeccUo). Ote-cMr.. 1916. adv. Sit. 



Durame's method of mocUoo of the dbov by the 
toterpoaitioo of a padaacalatcd fasdd flap b veO 
known. With thb amlhod a very satbfactory 
fuBctioa b ohtainod Darame has attempted to 
obtato the saan reaaha from the aaoM pdacipb 
applied to knee raectloos. The p roced an b aa 
follows: 

I. Formation of a *emiovd flap of the Mackaaab 
t3rpe by an indsioo which descends from tho adddb 
of the fm edgm of the catcnul femoral coadyb 
and theaoe pinw for aboal i cak aader the tibid 
tuberodly aad ftoiahn al iha aiiddb of the f m 
aarfaoa of tha laterad feawral ooadlyle. 

a. MoWHniion of tha tIbid tabaroaity aad 
formation of a flap tftfl** lo the 
the apoaenroebvtth porta of the 
BMati, from tho patollar KgaaMal 
iaaartloa. aad froin the pr'tff* 
of Ihb lap bam iha kan art! 
awbiSaad by aacdoa of the other _ 

5. Oaaeoat mocdoa aceordtog to Daraalols ovn 
BMihod, da., hf foradag ivo vodgn, oae hoOov 
aad the other falL both (iwHBpnadlag; tho flat 




GENERAL SURGERY — SURGERY OF THE EXTREMITIES 



M$ 



% 



tmertcd Into the InfeHor femoral 
by wmmm o( two oblique cuts which nm alflMMt 
pftnOel with the inclination of the inner 9iam of 
the two (enteral cockdvlcs, the tecond wedpi Ming 
nude at the expense of the s«tperior tibial cpiphyiia. 
4. Liberation by two loi^t**<liB*l sdMor cuts 
of the inferior •emldrcumferroce of the pnteUa, 
frsdag the head of the patellar ligament and the two 
f»««f|l— and suture of the patellar ligament by its 
oaaoow loaertion with the apeaaiiroiii and bending 
back tbe two aponeurotic flapa unhed bv their 

3tt opoo the bleeding surfaces of the femoral 
ea, maintaining them in position bv •otures 
fix their extremities to the retrocondyloideaa 
fibera. 

$. Coaptation of the booe>wedgea and fixation 
of the patellar licament. 

6. Suture of tae skin; immobilization for 10 to 1 5 
days, then passive and active movements in order to 
favor the formation of a neo-arthroais which will 
meet in the wedges an impediment to abnormal 
lateral movements; and in the presence of the patella 
and patellar linment in front and the muscular 
attaoiments baiind, obetades to the formation of 
genu antccurvatum and genu rctrocurvatum. 

W. A. BUXMAM. 

•latttt, A. T.: Nails and Screws Throogh Joint Sur- 
faisaa, in Autografts and in Practures Into 
Joints. /. Am, M. Ass.. 19 16, Ixvii, 114S. 

Mann has here proved that the knee-joint can 
stand much more traumatism and foreign body 
irritation than is generally conceded. He cites 
twelve animal experiments in which he opened the 
knee-joint in dogs, fractured the lower end of the 
femur at or near the epiph>'5cal line, with partial 
or comnlete separation of the fragment, and then 
repaired the fracture with or without accurate 
apposition, with nails or screws, and doMd the 
Jouit. He left the heads of the naib or screws 
exposed within the joint. The cases all showed 
ncccasful results with free, smooth motion of the 
knees. 

He found that the autografts united like simple 
fractures, and seemed to live; the bone trabectiue, 
however, bebg gradually replaced by new bone 
without the preliminary formation of cartilage. 
The naQs ana screws remained 6rmly embedded, 
and were usually covered with new connective 
tissue. The line of fracture in the cartilage tended 
to cover over with fibrocartHage if narrow, and 
with connective tissue if wide. R. G. Paocabd. 



C A.: General Principles to be Ob- 
in Bone-Transplantstiona. ifW. lUe., 
1Q16. xc. 49S. 

McWiOiana ghrca twenty principles to be ob- 
served in bone-transplantation. Most of the 
deductions are well known and appreciated by 
those familiar with the work and need not m 
repeated in this article. Some of the recommmda- 
tions deserving of emphaab are: 



I. Scrapnkma care is neccaaary la securing' tha 
strictest poaaJbla aaaprfi 

a. In general all rinaaaa aboiald be healed from 
two to three weeks before omklng an Implantation. 

3. A living graft aboold be transplanted with as 
much periosteum as possible. 

4. As complete hcmostaala aa poasibis sbonld 
be secured, hence a toumlqaeC ibowd not be oaed. 

5. After tranaplantation absolute Imfnobflha- 
tion should be maintained for from three to fo«r 
months. 

6. The inUy graft b preferable to an intra- 
medullary one b«cause in the former, endosteum 
comes in contact with endosteum and periosteum 
with periosteum. 

7. When operating on comminuted fractures the 
fragments should be retained and placed as neariy 
as possible in their original position, whether thie 
fracture be simple or compound. 

8. A graft should not be transplanted into the 
midst of dense connective tissue as its nourishment 
will suffer. F. D. Dicxsom. 

Pringle. J. H.: The IntcrpclTl-abdominal .\inpu- 
tation. BrU. J. Smrg., 1916, iv. aSy 

The author has now periormed this operation 
five times with three recoveries. A review of the 
literature shows that the mortality has been con- 
siderably lower in recent years. Of 34 cases reported 
up to iQOQ there was a total mortality of 75 per cent. 
The mortality of all the cases reported up to the 
present time, 43 in number, b 58.1 per cent. While 
one of the severest operations in surgery, the author 
b hopeful that with further improvements in the 
technique results may be still better. 

The indications are: (i) neoplasms arising from 
(a) the hip bone, (6) a femur too high for removal 
by exarticulation at the hip- joint, (c) musdcs and 
faacic in the region of the hip; (3) infective procesaci 
involving the hip-bone, (a) tuberculosis, (b) acute 
osteomyelitb, (c) actinomycosis, possibly in rare 
instances. 

The author Hisaisses the advisability of its per- 
formance in one or two stages, tbe possibility of 
modifications in the way of mcomplete removal of 
the pelvic segment according to the nature and 
extent of the disease, paying special attention to 
(i) prevention of shock, (3) outlining the flaps, (j) 
amount of bone to be removed, (4) control of 
hemorrhage. 

The technique favored by the author b mbrntdy 
deacTQ)ed and he reports in full his Ust two caaaa, 
both of which r e cov ere d . Hoaacs Bivkit. 

ORTHOPEDICS m GBIfBRAL 

Chnctsrtoa.CC: Merhaniral and Surgical Treat* 
asenc of TaUpss Dne to Ancestor raaaasfaMila. 

SL Fsmi M. J. 1916, xviii. 504. 

The author describes invasioo, eariy mechanical 
and surgical treatment of deformities of the foot 
due to anterior poUoaqrcHda. 



146 



INTBRNATIOICAL ABSTRACT OP SURGERY 



la tlw •oMc 
nilMitb. HglM 




Aft BWtllnd M Um 

In the roavalHo 
foe irvaimralMt: 
t. EkcuklQr. wkidi, in the •vtlwr't opialoa, b 

a. Miip. wkkli tiadoiibudly 

Mid aur alM ftld In the pctvwtioa of dalonaity. 
1. MMClMfainint. the wttlMr btltovw, to be 



or iiii clwrH y. 
im whkh meets bcM ol all 
Um Uwrnpratk laflwttooi becauM ibroufli n|>- 
pnntm the child obudM aMMd»4ffBiafaii. MMMgr. 
iIm» prtvcniiaf MHcb tlrala and i do t mkf aad at 
tkt maw ikM aoproidUag the nonaal tne aad 
iMKtinB «f iW AMCted limb or pan. The appara- 
iva, howrrar* ilwald be simple iod easy o( applica* 
tioa to aoonaiilWi the result rcqtdred. It sooold 
also be csafofftable, light ol weight, and plearim 
laappcaraacc. 

No sttffkal opefalhwi eacept the correct fcm ot 
aUfhl ddormkies ihoidd be performed in the first 
two yeaia. TW opifiriona daacribcd (or the cor- 
lectioo of foot dcfonMlMa aiez 

t. Bony opetatJoi; 

(e) Affthrodeeis 

(k) Astraaalectony 

U) Aftkolar iraaipoeitioB 

(«) Tcnoloaqr 

ik) Tranrfcfeoce o( tendons. 
TW anthor has loond the following tendon trans- 
operalhMS •ooocasful: (i) transference of 
haOiicis to the head of the fifsi 
bone; («) tra n t le tenco of the tibialus 
to theottiside of the foot; (t) transference 
of the pefOMoa longiu to the oppottte side of the 
Ibol or Into the tlMalus soticus; (4) transference 
of the pcroMol group into the icodo schOUs; (5) 
I operations, 
of forrign material: 

lU often ghnt satisfactory results, 

ovt of the timne after 

it produces a false 

W Tho whforrli^ of aaB-Joiau with silk liga- 

4. TW hipiinlatiiiH of m&nm into paralysed 
maedca hna boM Ified aip«imenially but iu 

5. Nerve aaoeiomoais has falod to 
tlonshi 

TW 

I. la tW acau stafs rest, warmth, and prevea- 
tka of dcforadty are siiO tW vital trestments, great 
to pieesal tW sprsod of " 






J. Only kliffht operations, 
streirhinc of muMir* will noi conoct defonalliM, 
gli^y^il^l \jf used in early Migir f 

4. Operations for jpenaaneat rrfief shodd W 
impinyirl aot earlier thaa two years after aa aorto 
attack. 

c. llodMuUcal tioataMBt long after surgical pra> 
cadMos b aO faaportaat. 

4. Matflatlag bonr OMiatioos should be avoided 
as far as pomBm fai rWilwa 

Osbn. A. t Pr sfealloa aad Uarfcatloa of Daforarfty 
ta Infantile P araly el a . Tktr*^. Cm., 191ft, si. 

Cohn believes that in the past then Wvo been 
many cases of infantile paralysb not dia^MOsd, 
espedaOy ia sporadic insisnres, Any case of a 
yotti^ diild with fever and pala in iW back or 
estreadtles should W watched for any paralytic 
flevelopawnt, for tW severity, of any such rcMUtIng 
deformity can be greatly lessifned by proper treat- 
ment. 

Under treatment, abtolute rest b all important, 
for early Mtting or fttanding through unequal pull 
of the trunk muscles and aqraMtric me t h od s of 
walking and standing or one sided use of affected 
arms tends to cxaiocenitc the deformitv. LwmWr 
puncture by reducing the fluid pressure a henefkla l. 
Electricity is probably worthless. SpUau to pre- 
serve normal poeiiions are very necesMuy. 

To regain nerve and muscle power; nnisde train- 
ing b moat valuable, a scheiltt by which tW elected 
part b put throudi a desired motion by voloBlaiy 
movement aided oy tW operator's passive aariat- 
aace. Thb b best done biefore a mirror, but tW 
musdca moat not W overworked. Hydrotherapy, 
BMMaafa, and baking are very uaeftil. but dectrlaty 
b qnaationahlf, certainly not advisable in the acote 
stage. Brsces mtist be intelliffently used, and should 
correct deformity, prevent further deformity, aad 
assbt in locoaBOtaoo aad support. Opantho 
treatment, which should never be done aalfl after 
a period of two years, i ncludes various lenotomha , 
muscle and tendon-transplanution, artWodaab 
and joint resection, insertion of silk Hgamfts, 
and nerve-transplantatioo. R. G. Psauaa. 



.P.J.t InlantileParalyste - lis 
nseai from tbeScaadpotac of tW 
ITif. If.y. t9i6,sv, 14I. 



lafaatile paralyab b aa iaioctioaa. coouBuafcable 
leaaa ciuaed uf lavaaion of tW brain aad cord 



bv a apodfk ndcioHWfaaiaaa. TW greateet daaaer 
01 comw M n i ca tloa b durlag tW early i i agea, tW 



iacabatloa period b six to eight days, bat tW 
vfams may reasaln on mocoaa aMasbraaea for fnre 
asonths. HeaamethylrnanriBa b tW oaly drag 
which seems to W of value, aad aWald W glvoa ia 
large quaatltiaa to cspoaed ckfldraa. Sanaa 
thacapy b paababjy vahiaMe;^s 10 so coa. o f aai aa i 
k loag aiaoa laoo'vaiad b n^iaciad by anmar 



GENERAL SURGERY — SURGERY OF THE SPINAL COLUMN .\ND CORD 147 



poactorr. and the doM rafWfttod tcircfml Uhms at 
uitcnrmb o( twcatylMr houn. SImot Um fHignwii 
QUUMM be nuule pfevioMtop«nl]riii, unr tipoMd 
chfld coiHWitnim 01 iodnpoHlMMit nratcw tMMW* 
ifadw paiaa, or restriction of neck motioQ, 

Jht tmtraent indndo auhacria, abiolute mt 
(vUch Lanfe rnforcet b^ i i w o Wl l Mtion o( the 
•piae in a pUster fthell). pmreatioo of contracture 
bf taitable splints, and in the coavalescent »tase, 
mMBOfe. muscle training, and poirihiy rlcctricitv. 
Sonical proccdum later in the course include 
teadoo-transpUntation or silk ligaments in oartial 
pnnhrris, astra^crtomy in dangle-foot, or arthrode- 
ris when a stiff joint is desirable. R. G. Packaso. 



Oitood. R. B.I Orthopedic am^mj te War 

J. Am. M. Au.. 1016. UvU. 418. 

Oifood discusses tbc part orthopedic soryery hat 
ia the iiifinf of physical ettdeacy in the ranks by 
1— w of attcatioa to postuet feet* and ******^*w - 

In regard to septic vooads aad Joiats, the ortho- 
pedist c o oserv ea fnactioa ia *** — y« * joiats aad 
where ankylosis is inevitable places the fimd Joiat 
in a position which assures the greatest ose. 

Oiiood found plaster-of-Pauis ditssiaii beat, 
using plaster bridges to span the opca wound. 

He urges conservatism m e«is ion of joiats. 
Proper apparattu and occupational training for the 
cripples are very important features of the work. 

Ccsns Las Hall. 



SURGERY OF THE SPINAL COLUMN AND CORD 



Yovat. J. K.: Roentgen DInteoeis of the Lumbo- 
sncral Regton. Am. J. OrtM. Smrg., 1916, nv. 

The author states that the final foxtot or absence, 
the location and extent of the disease or injury in 
the lumbosacral rrgioa, must be determined by the 
X-ray. 

The three groups of affections in question are 
concenital aaonalies, injuries, and diseases. Con- 
geattal anomalies consist of irregular formation 
of ooe or both transverse processes of the fifth 
lumbar vertebra and anomalies of the body and 
transverse proc ess e s of the firM sacral segment. 
Injuries include crushing of the bodies of the 
vertebrw, with and without fracture and displace- 
ment of the bodies of the vertebrw. Compression 
tof the fifth lumbar vertebra xisually results from a 
1^ (all, the patient landing upon or crushed down by a 
> ^""^^ from above. 

Tnt maffttmn of compression fracture are: local 
pain, pola oa rising or sitting down, local tenderness, 
limitatioQ of motion, muscular rigidity, scolioiia, 
and pressure pains. The X-ray shows compression 
of the fifth lumbar vertebra on one side with or with- 
out fracture of the transverse process. II the j»ro- 
ccas b fractured it will usually be observed protect- 
ing upward from the fractured surface, and there 
may be callus at the seat of fracture or later hyper- 
trophic arthritb at the joint and in the lumbosacral 
articulatioo. The symptoms of di^tlaoement in- 
clude: spasm of the musdes. pain, sc o li o sis with 
redcz paina, increasing disability, or coasplete in- 
ability to work. The X-ray shows marked devia- 
tioa of the spine with rotation of the bodies and 
—^ coaspression of the intervertebral discs. Later 
w Irypcrtrophic arthritb of the lumbosacral articula- 
V tion b seen. Ankylosb of the fourth and fifth lum- 

bar vertebrc b common. 

The traumatic form of arthritb deformans b the 
most common aad b easily recogaiaed. The X-rsy 
shows hypert r ophic mssses, nmad aad smooth, 
bulging from the bodies of the verte b ne, or sharp 



irregular exudates upon the bodies or articular 
processes. 

Tuberculosb b common, especially in the fifth 
lumbar vertebra. The X-ray snows rarefaction uid 
later an area of bone destruction and absorption 
with necrotic islands, with or without sinus for- 
mation. 

Osteomyelitis gives a characteristic X-ray picture 
of rarefaction and destruction of cancellous tissue, 
the disease being at the time sharply limited by 
the articular surfaces of the individual bone, as the 
ilium or sacrum. Specific osteomyditb shows more 
sclerosis and less inbltrating destruction of the bone 
than occurs in acute pyogenic infection. 

Malignant disease u very rare in thb region. The 
X-ray reveab an irregular mottled rarefaction with- 
out new bone growth, the rarefaction becoming 
more and more marked as the disease progresMa. 
In sarcoma the ossification progre ss es in an irregular 
and ragged way. The exudate presents a smoky 
appearance. Pmur Lcwtx. 

Guillot. M., and DeheUy. C: The Treatment of 
Pott's Diosnse by HIbba* Mocbod (Le tnutrmeat 
du mal de Pott par la oaahode de HibU). J. 4» 
ckir., 1915. xiii, 441. 

The authors have carried out Hibb's pperation 
in three cases, the patients being k, 15, and 4 jrears 
old respectively. The results obtained in these 
cases are summied up as follows: 

I. In three months there resulted a soUd fixation 
of the vertebral column. 

7. The three paticnu appear to be in good ooa- 
dition. but it is still impoerible for the authors to 
conclude whether or not there b any curtailment 
in the evohttion of the disease. 

J. The operation fixes the column but docs not 
straighten it. In certain cases the mam. that can 
be hoped for b a slight attenuation of the kyphoa 
by a mrrhanism which has nothing to do with 
strai^eaiag the column. 

The authors are of the opinion that every begin- 



INTBRNATIONAL ABSTRACT OF SURGERY 

to Ubb% 



14S 



itacejM of Fatt li _,_ 

iOlCaOd« Witll UM OMtpllOO Of 

■I* HI VMcIl COM fOCM WOOlQ bo 

•koold 01 0B]r COM bt kipc doMd. A poiiMt vltli 



Mmi or OM villi fod of mrgkol lobcr- 
vith • JmfMwtiA ofaMHt fhoold oot bo 



to U« dooblo iioc. ^^.j^n^ 



SURGERY OF THE NERVOUS SYSTEM 



OMi. C R.t latarko to cIm PtrtplMral Hm^m 
Ptt<MC>< hvModmi WartMO. Am, J. il. St^ 
l•l^dilJ5i. 



TW iohnte of 
oioooeboooio 



in tbit ortidc 

^ — ^■^— — —— ^ * — 

OOMrTUJOQ 

NcttOly^ 



i> ibt ^■wlroo AoJwiliiro Hoipltil at I 
SotaM^ ood opoo inpioHiow goincd by 
virilo to tbo Poriiboipltali, OS well m tbt botpitalt 
OMf tlw f ioot« oad ******* ti^yfttlffB botpitola. 

lo tbb oitklo. io ipcoklac of tbttaJoriM to tbe 
pwipb^ol OMvot, tbo oatbor bmooo oolv tbow in 
vbicb tbo wooodi pradttot toow OMrfced nualytic 
oloct,diMoltoit«rif. 

Tbo mmmmIoo of functions nuv be due either 
to dkoct vtoleaoe of tbo odnfle, flymf frofments of 
booo, or to tbt lOMlloDt b giu o iih ay and cedcma 
of tbo port or to dcotridal pr ow ui ie daring bealing. 
Tbo Mboeqaent dl mM Uty nay bo motor, lenaory, 
orbolb. MiM CMM of loM of fttoctloo in the band 
or fool, from wooada witb luemorrbafa or ordema 
bitbo ottfoodtka abovo m a ntl oood, dear op rapidly, 
pfovidmc tbe part ia not immotwliiadi 

Craig bdievcs that tbe giootoat kaaoo learned in 
dM war. fai taking care of travaded 00 a laiie scale, 
is to avoid immobiity of tbe iroonded atfoodlles. 
Socb moWHMtloo produces what S. Wdr lOtcbell 

This has been avoided 




tbo ostranitic^ tbe iniieQuency of completety 
Oi Oi io d nerves is quite trmsrksble, *'«'*THnt l«s 
tboa ten per oeat of tbe caam of pc rip hcr d nenre 
bdory. ronmbhli severed nervctninks are 00m- 
poratWahr mie; bowerer, sU tbe ftymptoms of 
cwpliiiiy cot nerves may be present nom coo- 
tasbm or compnssion of tbe nerve. Tbe propor> 
tfaoofpMbibmBlMrvoinJodm to the total number 
of wonaded loao oppfosfaaatdy as follows: 



UlMr 



Sdodc... 
Obcwnior. 



IS 

9 
9 
S 

4 
10 



Ftomioiurim 
r sboi oad sbi 



per cent. 

per cent. 

per cent. 

percent. 

per cent. 

per cent. 
0.5 percent. 
o.j percent. 
M percent. 



— to tbe psiipbsfol , ^ 

sbdl, Craig draws tbo foOowfaig coo- 



I. Loosmlloos oad ooatadoas may bo dif■^ 
entlatad« usoaOy by coiofoi aowoloilc ^■-'■■ifirn 
In tome cases, o i pos nr s of tbe oervo st the alto of 
the injury Is tbo only OMoas bv which tbo onct 
k a ow l od g s of tbe nature of tbe luary to tbo aorvo 
la obtafaMd. Ndtber tost of foactioa nor dartrical 
reoctioo wID dlfsnatklo coa ta do u from locwalJon. 

a. Casm of sbapio mnfnsioa rsoover dow|y, and 
as a rule, completely. 

J. Guasbot or shdl wounds, causing laosrotloaa 
of tbe nervea do not lend themselves readily to 
plastic operations. Because <A the infection, weeks 
and months mu»t elapse before plastic work can 
be undertaken. During the ten months, no rsoov- 
ery in such cases was obasrvod. 



EmilC 



BSMCC, 



A.: Wounda of the Limb Norvoa 
Prolectilea Baaed oa Fc 
witli Bod-Raaahs (Plaits des 
par pcoisctiks da gume d'aprte 14 cas opMs avec 
rssaltsti doignis). ibs. d« tkir., 1916, t, 754. 

Tbe study of 14 cases of injuries to tbe nerves 
of tbe limbo leads Basset to the following oondn- 



I. Lesions of the peripberd nerves by projectiles 
are more generd in the upper than in tbe lower 
Umba. 

i. Primary injuries (even in the case of bullet 
wounds) are ver>' often infected. This infection is 
important from the \'tcwpoiiit of exti 
on account of the abundance of dcatriaed 
tisne which compresses tbe nerve. Section of tbe 
nerve owing to such romprrimion b rare, bat sacb 
cniiipwrnioB eiocts iriegalaritiea, nododties, and 
sometimes more or leas strangnlation of tbe aervo. 

5. Operatioo consisu in eitirpatiiw tbo fbroas 
tlssoe as completely ss pomlbis, a carctal smonthing 
of tbe arigbhoring awiious sarfacea, fresiag tbe 
nerve, and abrading nodoshim or other liregnlari- 
ties. 

4. Resection b JadJcoted only wbca electric 
reactioa shows a complrto bucnnptloa, or if tbe 
lesioo of tbe aervo-ttaak b very grave. It b 
ncccsiary to proloct tbo aervo agdast rsiteration 
of innuiiiiminn by some awoas aad tbe author 
rsoomaaads a tUn caoatdwac strip plaead about it. 

The author reports opoa 14 casm wblcb be operat- 
ed upon, nine to thirteen oMmtba previoas. Oae 
has been lost to view, aad s show ao oaMttorstion 
after satare of tbe aervo. Of tbe reamiaiag 11. 
losbNM of tbe aervcs of tbo apper Baibs were dis- 
tiaetly amre favorably aiactoa by ibavBlioa tbon 



GENERAL SURGERY — SURGERY OF THE NERVOUS SYSTEM 



«49 



tboie in the lower Umbt. Of 7 intenrentioiM 00 
the apper limb a have given fmcctteat leNlts; 
t good; I (airiv good; and a Moderf icedta. 
In the lower limb 4 interveatioot have given 1 good 
result, I (airly good, 1 moderate, and 1 bad ronlt. 
Oweoui, vascular, or mumilotendinoMi lerioM 
•oawtimea are aaiodated with the nerve leiloai. 
Ob accoont of this the infartton of the traaauOiied 
ana Is most ponittent, the cicatricial tissue nor* 
abundant, and the nerve may be even directly 
injured by bone fragments, remltiag in functional 
Hyyithciii is more frequent than 
and more or less eiacasive paralysis 



diaahUity. 



may be ob s e r ved even when the electrical reactions 
arenonnaL 

Operation should not be attempted until the 
wound has com|>letely dcatrizcd. If there has 
been a fracture it is not only necessary to await its 
coosotidation but even to dday some weeks, other- 
wise there is risk of reawakening a latent infection. 
Operation may be undertaken at the end of about 
time months if physical methods have iK>t led to 

W. A. Bkbkmam. 



R.: Traneplantatkm of Nerves 

(Transplantation des ncris). Ly^m cUr., 1916, ziii, 
SsS. 

IngdMictsen reports the results of his investiga- 
tioos made in the Pathological Institute of the 
University of Christiania Clinic. 

He d^nes transplantation as the complete libera- 
tion of all connections of a segment of nerve and its 
implantation in a living organism. TUs procedure 
may be autoplastic, homoplastk, or heteroplastic 
The questions that arise are: 

1. Can a nerve segment survive after trana- 
plantation? 

2. If transplanted on a sectioned nerve, can the 
segment contribute to the regeneration of the nerve? 

J. How can this regeneration be effected? 

The question of the survival or death of a nerve 
segment can be judged by examining the Schwann 
cdls of the segment. If the>' are multiplied the 
fact of survival can be affirmed. 

The author has made three series of experiments 
on rabbits by removing small pieces of the sciatic 
nerves and implanting them in muscular tissue (i) 
in the rabbits from which the sections were taken; 
(3) in other rabbits; (3) in guinea pigs. The sections 
were removed later at intervab var>'ing from 
four to twenty-four days. The results obtained 
in regard to the autoplastic and homopUstic im- 
plantations were that there was a Wallerian degen- 
eracy evolving in the same way. but a little slower 
than in the permheric portion of a sectioned nerve, 
there was a multiplication of Schwann fod and an 
immigration of phagocytar^ granulous bodies. 
On the contrary in heteroplastic segments no Waller- 
ian degeneracy nor roultiplicatimi of the Schwann 
fod was found. Twelve to fotuteen days after 
transplantation the segments were quite necrosed. 

These results are quite in accord with those of 



Ranvier and Merdiadwr, while they differ from 
those obtained by Ruber, BaUance and Stewart, 
Berga aad M a c ea hr onL The coo d u si oo a to be 
drawn from them are: (1) Since heteroplastic seg- 
ments undergo necrosis it Is oeeiem to try a traaa- 
ptantation with them in losses of nerve ■wfiy^tnfip 
(a) Repair of loss of nerve substance moat be 
efleaed dther homoplasticaOy or autopbstically. 

The author has gathered from the literature 
reports of 3a cases of nerve-transplantation in man, 
the first by Albert in 1878 and the last by laboulay 
in iQii. Of these cases two are autoplMtks, 6 are 
homoplastics, and u ere heteroplastica. The 
author rejects most <^ these reports for want of 
sufficient data and reduces the total number to 14 — 
I autoplasty, ^ homoplastics, 10 hetcroplattiea. 
The heteroplasties showed only 10 per cent successes. 

The author has made three series of experiments 
on rabbits to test the value of nerve-grafting, by 
resecting about 3 cm. of the sciatic nerve and joining 
the graft to the two ends by vaselined silk sutures. 
No attempt was made to prevent the formation of 
adherences, etc., as the author believes such to 
be injurious to the transplant. The «'* pf^m ynts 
made consisted of 1 5 autoplastics, 39 homoplastics, 
8 heteroplasties. 

The results obtained by the author were: The 
autoplastic segmenu were removed and submitted 
to histologic examination from ao to 163 days 
after traiiq>lantation. In all the tranqilanted 
segments he found numerous neurofibrflhe which 
had penetrated in the segment of the central end. 
Twenty-one days after transplantation tliey had 
penetrated 12 mm. in the transplanted segmenL 
From the 136th to the 163 rd day the rabbits had 
regained normal motility in the limb and walked 
like healthy rabbits. 

The homoplastic segments were removed from 
30 to 63 days after tnuuplantation. In all segments 
examined the author found neuro6brilhr which had 
penetrated the transplanted segment. There was no 
appreciable difference in the regeneration of auto- 
INastic aiKi homc^astic grafts. Electric stimula- 
tion showed complete motilitv of the limb in 
all rabbits with homoplastic grafts examined. 

The heterogenous grafts were removed from 1 2 to 
63 da>'s after implantation. They were ydiow, 
necrotic, and had lost the consist enqr of living 
tissue. There were no neurofibrflhe of neoforma- 
tion, but in all cases there was a diffuse and con- 
siderable mononuclear infiltration. 

The author has satisfied himself from operi- 
mental research that better resulu are ohcamed 
by transplantation of nerves than bv suture; and 
he thinks that the latter method sho«ud be replaced 
by transplantation, which b certainly superior. 

W. A. 



Law, A. A.; Brachial Plexus Surgery. J. Awu M. 
Au., 1916, Uvii, 865. 

Direct trauma was formerly co nri Jar e d the most 
frequent cause of injury to the brachial plena 



ISO 



DfTERNATlONAL ABSTRACT OF SURGERY 




•■ p i rt i ww uiiott by Hontey aad ml 
' iivdy ol tUolQ|k MtdMaks 
dMiVlwy oTuit pimt «d 
Ml fftqpMlljr rmii frooi phtrhtm tbcni b t tfw m 
tlw im t(b» Mrt railirr from ikdr focdbit awMiM, 
vUdi law iW eovdi «M bjr tW root*. In ihr Inter* 
vwubfil uid iMttvtitibfal caMt, Ami rupiurrd 
bttvwa Um mIm nad tlw uilla 



neoiM atfvit. wkOc tlw cacnmiioa to the vpiwr 

Md tkoMm nuy be Inuct. 

A CMt it npottad In whit h (our tad • half aoMlit 

after ln|ttry. apcratkM »howcd nminii of tlw 

muKulcKuiancoM; thb wm r«atclad aatO tlw 

aorawl fnarkaU of batli itaava arwa dMenalaad. 



Tlw tiaa^it awa ■npmilaiaiail aritk 
gut ittturaa and tbe Uiw af aaiaa ara* * 



la tlw tanadavkalar ar tafkadaaicalar typm. 
TW iJilhihr Urfr number of M^allaa cai 



anapfwd wiib 



**biitli^lllM** in inUnt*. whkll at 

bwiB lapartad* Itnd coaarawtofy 

aaaWaa af tlw btaddal plant traakt coawt from 

ladkact vtohact. far km ibe upper cofdt af tht 

plasat art tara ataadtr ar oat of tnc foramina them* 

tthrtt. by cstrrme iractloa of tlw theal dcr away 

ftaai tlw btad in the birth of the child. 

Ntnw t which art fordbly avubcd arc injurrd in 
a aatCly dUlctmt way tbaa thotr which arc drlilM'r- 
alaly ar aoddaatly cat dcaaly acrott by a tharp 




la the avulted trunkt the boadlat of 
aiatoraat diflrrrnt levdt aad are f ravad aad poBad 
apart aad leverciy trauawliatd, tlw tadeata r ai 
blaad«iwtttlt ara tora, hgawnaay occait la tat 
thiath. aad tidt witb the traaaw of tht acddcat 
aad tlw hamorthtit aboat tht aw^tt rtt u l u to the 
of tear tlitat^ther to the 
i or aboat tbem. 
Later, tear oaatractloa ranUts in multiple neuro* 
aiaioot aadakt aa the traaka. which prevents the 
pia|tctloa of the pradaud aaoac* into the dbtaJ teg- 
awalttOr the cooiractioB of the perineural connective 
littae Mrmogttlalcs tlie fiber* to the extent of parti> 
ally or whoUv toterfering with conduction, which 
lanilthlj b uallowed by trophic rhtngrt aad aiotor 
paralyaia. 
of bttfMal plant tojury or rupture 
It arc injured. In 
the appcr arm or " Erb-Dadwaae " type, thb 
iajary feaerally occun to the fifth and mth 
to the orifto of the tapra* 
therefore the tupraipiaatoat 
are paialyatd. The charac- 
tcrblk aliaplqr of thcte aiaodat occait aloi« with 
iaward lacatioa of the tlwaldtr aad arm untO the 
haad aad fotaarm it to titi a a w praaatloQ. Wing- 
tof of tbt trtpalt whca the arm it hdd horiioatal 
It tbowa whaa the tojury b high 
to be above the origto of the toag thoracic 
b cauwd by paralyib of the terraiut 

or lower arm type, the eighth 
aia laaolvadt 
tatbtai 
cataaeoat, aad letter toternal 




a |ir<iirlcd fatdal ftop from the ttaa^i of the ptc- 
awjor. The dubbed dittal aad of ibt 
wat rttected and iaytoatad by aa 
aaaaioBKMb toto a tUt of the awdlaa 
atnra aachorad with chromic catgut, aad the Itoa of 
aaloa wrapped with a pediclrd fUp of aifllary faL 

Thirirrn monih» later, by re-educalioa, the 
patieat hat nearly a aoraial rrtura of all the faac- 
tloot of the ddioid. cortcobraddaUt, bkapt, bca- 
chialb aaticttt. aad trioepa; ht coald tiltaa. tepto- 
atr. aad proaaie the foraarm faMy wdU iaa the 
wrbt aad the aeooad third and fourth finger* well. 
the iadeS'ftogtr tliahtly. aad the thumb not at alt 
The cxteaton of tat latt tbree fingen show aboat 
75 per ceat ftiactloa. Saaaaiion rrturaed escape 
over Ibe radial half of the forearm aad haad, ar 
cor wapoadia g to the dittribution of the anwcalo- 
•piral. muacuiocutaaeout, and radial aervca. 

In the Mcood operatioo, all the cordt were fooad 
bound down by tear tiitue acar the adddle of tbe 
plexus. The fint aad aecoad cordt jatt after they 
eiaerftd from the foramina thowed defbdta acaro- 
Biatoat Bodular enlaracmcaU aad tbt ddMh 
cervical aad firM dorMU acnrca were buckled on 
themsdvet aad rdaatd ahteagh they still were 
adherent by connective tbaae to the foraadaa. 
Faradic stimulation showed ao r mp o at e from the 
ulnar. The ulnar nerve was sectioned Ugh aad by 
an eod-to-side suture was united to a aoCch ia 
the musculocutaneottt, that beiag the traak ff^/iag 
the greatest faradic ritpoatt tad the liae of aaloa 
was wrapped with a free fatdal fUp. 

The entire brachial plexot was thea covered by 
a p edided (Up of ajdUary fat to prevent re-fonaatioa 
of tear tbtoe. 

Four and a half months alter operatioa. the 
trophic improvement in the limb waa awikad, 
sentafioa Iwd returned to the arm aad fortarm 
dowa to withto two inches of the wrist aad there 
wat abo trattlion in the thuttb. 

The c o Bcl a ti o B b that while aoae of the reported 
of avabioa to the adult in which operatioa 
complete reco very, ttfll 
faactioa waa laplatd to Jatlify latere 
fereace. Sack mtaotiaact thoald iadadt aen^a* 
transplantation whca ladicatad, at tke dlaical 



and experimental e vldtac a kat proved tke 
of rt-odacatioa. Locua H. 



GENERAL SURGERY - MISCELLANEOUS 



iSi 



MISCELLANEOUS 



CUHICAL BNTITIBS-Tnif 0R8, ULCFRS, 
AB«C18Mr8, KTC 

. G. M.: TiM VahM aad thm DmMv of th* 
BkMjr la tlM OliiiBOito «f GMmroTdM 8kla 
9md Mmemm Umabnm, UtU. (r Cmm. Mm., 

1916, U. S«6. 

OboQ belittles the danger o( removing a tauU 
piece of tiMue (tbe of a grain of wheat) or a larger 
piece removed by the cautery for diagnostic pur- 
poses. Cancers of the ftkin and mucous mem- 
waaco bleed frequently and scabs are picked off 
bjr the patient causing blrr«ltn(( without rapid 
mftastasts Prickle-crll epithelioma cells early 
fanrade the lymphnnaces and vesseb thus caosiBf 
BOtastaois which ctoes not result from nicerated 
area iavaaioQ. Thus he thinks biopsy increases the 
danger of metastasb only to a very slight degree, 
and then only in the prickle-cell variety. The 
advantages of biopsy more than offset this danger. 

His condnsions are as follows: 

I. The danger of metastasis following a biopsy 
in cancer of the skin and mucotis membrane nas 
been very greatly exanerated. 

a. An earl^ and absolutely certain diagnosis is 
so important m cases of skin and mucous membrane, 
that a biopsy should be made at once in every 



3. The biopinr is the BMSt important single 
method in the disgnnsis of cancer of the skin and 
mucous membnuie. 

4- The following conditions simulate cancer of 
the skin and mucous membrane: syphilis, tuber- 
of the skin and mucous membranes, certain 
of the skin, benign tumors, and precan- 
eskms. An absolutely certain differential 
can be made in each one of thcw coo- 
by the biopsy. Cabl R. Sibdodb. 



F.: The Rdatloa of Arteriosc l eros is and 
Other Anatoinlcal Chantcs of Old Age to the 
DsvelopOMat of Epithelial Malignancy: a 
Sto^jr of JMGsacs of Carcinoma. Smrg.Gymee. 
(rOkit., 1916. xxiii. 41 J. 

Numerous research workers have referred to the 
frequency with which malignant growths are 
ssso d ated with obstructive endaneritis, con- 
nective tissue increase, aiKi lymphocytic infiltra- 
tion. Some, in support of the anatooUcal basts of 
the cause of cancer, have gone so far as to contend 
that obstructive arteriooderosb and connective 
tissue increase are usually present, and that they 
bear a positive causal rdation to the production 
of carcinoma. 

With thb thought in mind, the author undertook 
a study of 306 cases of carcinoma to ascertain how 
constant a relation these conditions bore to cancer. 
In addition to this he made a study of a coMidcnible 
number of i pf i rimfi i s , aa a control series, of ocfUM 



rem oved for various ^ 

from paticnu of the so^aOed cancerous age. 

The result of his study was that of the ao6 cases 
of carcinoma of all organs and regioBS namined, 
loe showed arterial obstructive changes. This^va 
substantiaUy an equal division between endarteritis. 
50.06 per cent, and normal vessels. Fibroiic 
changes were present in 118 cases, 57 per cent. 
Ljrmpbocytic in&ltration was present in 85 cases, 
41 percent. 

That endarteritis and the anatomical changes of 
old age cannot be looked upon as a constant factor in 
the production of cancer u shown bv the fact that 
normal \'esseb were present in almost half the 
cases. The same held true in relation to connective 
tissue increase. Lymphocytic infiltration, wUle 
present in less than half the cases, plays a r<Ue 
that b protective rather than etiological The 
author found that many uteri, with normal vessels, 
showed cancer-cell infiltration and normal connec- 
tive tissue. Inasmuch as so many of the non- 
cancerous uteri showed the so-called old age con- 
ditions, one would expect to find cancer in them 
more frequently, if they are a positive factor in 
the development of cancer. Lymphocytic infiltra- 
tion, even when present, varied greatly in amount. 
This was true not alone of the cancers but also 
of the various tissues used as controls: in some 
cases being very pronounced, in others quite slight 
in amount. It was especially marked in the rapidly 
growing cardnomata. 

The author concludes with the statement that 
certain biochemical factors of a local or internal 
and general type are probably responsible for some 
cases of cancer at least. 

BoTM, H. de B.: Colcy's Mixed Toxins in the Trcat- 
nscnt of Sarcoaaata: Report of Four Casca 
of Osteosarcoma Trmtad by This Method. 

J. ilUk Si. M. 5«r., 1916. XV, 497. 

Detailed reports are given of four cases of sar- 
comata in which toxins were used. Three of them 
were examined microscopically and proved to be of 
a giant<ell t>'pe arising from bones. These three 
were operated upon and given the toxin as post- 
operative treatment. 

The fourth case was a huge sarcoma of the antrum 
which was inoperable. All four cases are well 
a 3rear after, ana show no evidence of metastases. 

H. G. SiOAii. 



H. C; Balanco of Power in Infection. 
Tr. Wat. Smrg., Att., St. Paoi. 1916, Dec. 

The author points out that in certain infections 
of the more or less chronic typeSL tubcrculosii, for 
example, warfare b often waged a aaay SmnatL 
fields b the bod^ at about the same time; the battle 
may be going fairiy equally, or the invaden may be 
having somewhat the better of it; under such ck> 



»$» 



INTERNATION.\L AUSTRACT OF SURGERY 




kMgr bt 
!• llMald «r tki ' ~ 
■•srht calltd**btiucc of power' 

WoikiMr^ IMMMI ki tUi M^lKt ttM chMljr li 
tlM dWol Mptdi tt pfttwUd !• t luft mnidMr «f 
lubrfcvloM Im&Mttm coaliif to Ootondot bmbx 
of vlMMi pniwi milliplt iod of iyitctioBt oMay oif 
Mt iniiMhli to fuikal tfoolatot. Ho 
rtwiolorii, witli oraltiplo 
fdd of tW Ji i M ii. towly woJM o p«o tob i i ciii ooi 
lolocttoo; tku oiW onulHM tio oagraftcd opoo 
oad loto llw ilioniiil tkmm ud otfMt, lo tliat a 
■ted loiictloB ooono In uid oboot oMmr of the 
piinoffy lobMCotow Moat. It b oioit oftoi b 
fod of Miaid Irftcttoo Umi the nccenity for 
oriMO, and it b la todi adds 
BMy do the moM for tbo 
Ho beUoveo' tbat aaoriMd fod of tuber- 
Mtctiea rarely leqalio opea eonkal treat- 
. tboee «Ub eagnhod eirnplocooaMj 
MapbytoooocaSi aad ooloa badUait or otaer mind 
aSaHaa faaplaated bto tbem are alinoet la variably 
hAdy daaaiioai to ibo paticat, aad eooo bffft t ne 
a properMd for earikal htarfeieaoe If tbe balance 
of power b to be cetablbbed for the defcodcre of the 



lad afiM^CBia an adaalily oidend to eave 
Mma, aad oibiaitloa tm tbe patieat. aad 
vod froei a loag aad badly nwaagirl aa> 
I tbe lift befiM very linrfftliat 

a nadfcr lad aeoae to tbo 



llaay faclon eater at dements of tocccm or 
falart. to that the author be U evee it b not too mudi 
teeay that the mhetaadard rbks call for a nicer and 
iaer euikal Judtmrnt aad akIO than almoet any 
other da«. Every detail — the choice of the an- 
■athetic, and of the ODcnuioo. tbe ftkill of the surfeoB 
aad the after-care, tae anning. nutrition, and the 
■eallaliiwi of the alcfc room — make for nicccat or 
falare; aotbfan, however, appcan to be to important 
as the idectloa of the right time to operate. Op- 
cratiooa doriag the earlier aad more acute atages 
are beUeved by amet aurg eoo a to be very onwiae. 

Maay phyddaaa aad am gaon a la Colorado, of 
laqpi encrieaoe, bdieve that aoch caeca of surreal 
tabeicahMh do better bdore, during, and after 
the operation, in Colorado, than in the duUer, 
daa^ier. aad lover couatry about. The author be- 
Uevea that the many day* of enaahinr, the dry 
elwnaphitf. aad the altitwle are Important factors 
fai hdpiag to briag about good reenlta. 

Thoe are BMtty ageadea at work which retard the 
grffiTth and dtvewiwaeat irf tht irthrlflgif . pt!hftggn if , 
and aaprophytk orgaabnia which cauae theae coo* 
ditioaa. The beet leaalu appear to have followed 
operatlooa for the evacaatioa aad obUteratioo of the 

aad the raaiavalol aa orgaa, taeivactioa of wUch 
haa beea inat|y fa ap ali od or totally dcatroyed by 
■ahlpli itCMiM, aa amy be the caee with a kid- 
aey, a taetlde, or evea a faaac. The eflfea of each 
oprralioa la ladadag toaMBM, the eHwinetioa of 
Ibd Ikam which the ttadoa of dbeaae takea placa. 
b at oace appaiaat la the ■aihod jayiovemiat of 
the tian at which the operatloa b 
thedetalaof preparatioa, op* 



daaMfMtbaaea aboat the tabenalooi foci, aad, 
lavaduig theai, briag dbofgudaatloa aad decoai> 

aaia. Ro- 
ofgaa taraa the 
chaacea for lo- 
cavary are at oace 

EwtC. 



Sberrin. J. G.t TrawBodc AephyBla. 
5arf. tr Gymtt, A$$., White SalplMr 
Dec 



flBOval of the devttaliaed, aaptapaic 
acale la the patieat*a favor aaid hb 



TV. SmiL 



the aatieal. 
daaebw3 



Sberrin repofto thecaae of a bddg»4Miilder, aged 3c 
veara, who waalajorad by belagcaaght aad iqueieed 
between the enda of the top chonH of a new tmea 
which was being placed in final poaltioo, doobUag 
him up and brinjcina hb head dowa oa hb kaeea. 
The weight of the chorda waa veiy gicat — it wae 
eatimatctl the end which came derwa opoa him 
wdfhed at least aevea tooa. No acmrate etetemrnt 
of the time this chord waa preaaiag upoa Urn coald 
be obtaiaed, but it must have beea of nrid daratioa. 
He presented marked ccchymoeb aad awelUag over 
the need and forehead aad down to the cheekooaea 
on the face. Thb area waa dark purple la color 
and cleaHy ddineated by an abrupt maigia where 
the healthy color of the »kin joined the awoOea db- 
colored part. Premurc did not aflect the di ecelor a - 
tioa. There waa nreeeat a eobooojunctival lueaa- 
orrhage 00 each ude which wee bright red, coa- 
traatiag strongly with the purplish dl acoloratioa 
of the adiaoent timuca — a strikiog aopearaace. 
Rupture of each ear drum with hcmorniage from 
the car caaal waa aoted. Bleeding abo o c c an od 
from the noee. There were no other iniuriea ea> 
ocpt a few minor bruises and a fracture of the sev- 
enth rib 00 the right side. Tbe patieat waa fully 
coaa d o oa and the reflexes were normal, with no 
evidence of cerebral injury. The pnpib were equal 
and rc^oodve to light and accommMatloa. 

The dicgnoib of traumatic aaphyda waa ooa- 
firmed by tne eobeequent history of the caee. The 
discoloration of the skin cleared up prooptly la 
about three or four days, that nadcr the coai«ac- 
tiw perditing much looger. The patieat re- 
covered without oatowaid laddeat. 

From the atody of the literature at head tbe coa- 
daaioo amy be reached that the coadition ueaaOy 
readta from aaddea aad fordble coa^aaHba of the 
deat aad abdffBMfBi whie the head aad perhape the 
aitreadtlea are aot nnrnpreaiatl la thb caee, how- 
ever, the Back waa poahed forward finaly toward the 
cheat, iiiltlai la the ooaetrictioo of the veiaa hi 
the aeck aiariiar to that occnrriag from etraagala 
tioa by haagbg. Thb caae seeaaa evea oMre 
atioagly thaa the othen reported loihow that the 
dbooloratioa b dae to bcioaaed veaooa peiMueL 
althoagh oMet obeerveis have held that t&a b of 



GENERAL SURGERY — MISCELLANEOUS 



IS3 



id Um fact and kaad btCMHt d thenidi of UitM 
support aad the inrnnmilMfo of Uw valves. TUa 
cootentioa to ako aupoottod tjjf tlM fact that b tbe 
caaa npovtod by Bolt tba diMolofatloo occurred 
ovonrwaare over tbe (ace and bead ocrpt wbrre a 
wamfiy ftttJag cap preaaed vpoo tbe bead. The 
aame effect b »hown by tbe preeaure of tbe collar aa 
■oced in Wiaelow't caac. 

Ihte patbology of tbaaa caaea ooMiila fai diieolora> 
tioo of tbe akin from voaoua c HUwth w or bsaaor- 
rbafB in varying dcfite; tobcoojunctival bnDor- 
rbafe, rapture of tba ear drum witb bcmovrbage 
from tbe canal, and rnJataTia, and awcUing of tbe 
akin. Tbe latter and tbe diacoloratioQ alao ia 
Uadtcd to placet that are not aobjected to sopporting 
pfcaanre ajMl usually extends no lower than tbe 
clavicle, altbou^ in soose rare inatanrra there is 
some discoloration in tbe axflla. Discoloration in 
tbe soft tissaea disappears very promptly in the 
coarse of a few days; that of the conjunctive at 
tiasaa persbta for several weeka. Coincident in- 
jurica, of co u r se , make the other pathological changes 
different in can case. 

Ukually there are no cerebral Icaioiia present, 
altbon^ in aoosa jnatawtia transient Windnesa has 
been B<rtfd. Tbia abacnce of brain lesion baa been 
attributed to the fact that the veins supplying the 
brain are supported properly by the surrounding 
tisanaa, wbicn is not the case in the more super- 
ficial vdna. In the Utter the inadequacy of the 
vahrca can be proved by the fact that the injection 
of tbe vena cava in the dissecting room distends the 
superficial veins of the neck, while those of the arms 
are unaffected. 

Tbe sjm^oms of this condition are marked dis- 
coloratioo m the skin of the head, face, and neck, 
aiKindlm down to tbe clavicle. Posteriorly there 
ia fa aome caaea marked extravasation over the 
trapeaiua muscles. Tbe ears are somrtimea not 
involved, neither is there discoloration nor swelling 
onder a tightly fitting cap, nor where the pressure 
of a ooDar supports the neck. The conjunctive 
are verv red and in striking contrast to the purple 
mot t le d appearance of the remainder of the slun. 
Tbe lips and tongue may be somewhat swollen and 
together with tbe mncous membrane exhibit the 
same purplish tint aa tbe skin, and bcmorrbagea 
may occur from the noae and cars. Tbe patient 
may be momentarily unoonadonay altbovdi tbia 
symptom is not frequently seen, and dfaappears 
in a abort time. Of course one must not ovolook 
tbe poaaibility of concomitant injuries of a serious 
nature in tbcae caaea. The discoloration usually 
rather promptly, except that under the 
which perusts for a longer time. 

is usually favorable, recoverv 
takinf |i^oe in moat cases quite promptly. It will 



■Kivie m u 
disappears n 
ooimnctivc. 



, of course, to a large degree, upon the amount 
of pronueand thelengtbof time which it b applied, 
aa wcO aa the gravity of coincident injuries. From 
the natttre of the injury and its manner of oocar> 



•miIcbI aid can rardv be bad immediately: 
whan pomibla. tbe Immadiala nae of 
artificial wapfralfcrn and osyfoi abodd be eaa- 
ployed. Uanalhr ahock b slight, except where tbe 
a rr o mpa n ylf miwka are severe. Tbe aobae- 
liTHUrt Hovld conaiat fai ^^o— »^»fl^| i f ig f b«»fk 
tbe patient at itat« and 
arise. 



rrat treatmeal Houd coo 
it b nrfient, keeping tl 
marting indlcatlooa as they 



DeGaatro. A.: 
DIaoaaa (Ac 

hatttta). A'l 



•t amiaifie ds RachlfaM* 
d« la 5afM. 1916, xxvie,j4. 



In 1913 DeCastro nnhHahed tbe report of a case 
observed by him in whidi acromegaly waa dioically 
associated with Recklingiiaaaan'a rtisease. Another 
case has been reported since. Recently Roohino- 
vitch and Sotidiere have critidxed tbe coimection 
of these diseases, and in DeCastro's case think that 
the proof of tbe involvement of the pituitary gUnd 
b incomplete, especially tbe radiographic proof. 

DeCastro has recently been able to again observe 
the patient who came to the hospital in 1914. 
Radiographs made demonstrate hsrpophyseal in- 
volvement. There b considerable enlargement of 
the sella turcica and separation of the anterior and 
posterior dinoid apopbvsea. 

The man died shortly after in tbe hospital and 
the autopsy report showed that the hypopoyab was 
very voluminous and orojected into tne cranial 
cavity. Besides it had developed two Uteral lobes. 
The part of the hypophvsu lodged in tbe sella 
turdca was small and reduced to a mass without 
consistence. W. A. BaxxxAK. 



BLOOD 



lldtx-Boyer: IlKouitoaui and 
(Hcmatomc et 
1916. p. 394- 



gsariiirj PresM mM. 



Referring to cases recently obaerved by him, 
Heitz-Boyer caUs attention to the relations which 
exist between certain hcmatomata localized in the 
limba and the appearance in the underl3ring seg- 
ment of gaseous gani^ene phenomena. Sndi 
bcmatomata due to a loion of the larger veaaeb of 
the limb are in the beginning of great uae in arresting 
hjcmorrhage owing to tbe pre ss ur e exe rc i sed ; but tUs 
aame compression exposes tbe patient to a formi- 
dable complication, i.e., gangrene, which in the 
ftianiciea of war b almost aJways gaaeooa. 
Tbb gangrene, which might be called secondary 
gangrene, has in the different caaea ob a e rve d by 
Hdta-Boyer developed in tisane dead owing to 
vaacular disturbance. Tbe devdopoaant of anck 



gangrene b often quite evident, aa in a rsceat 
of Heita-Boyer in whkk an itarntive 1 
hcnaorrfaage of the forearm neremJlitiid a 
ligature and in which gangrene d e veloped wkkfai a 
few boors. 

Hdta-Boyer thinka that vban ancb a iaigfwi 
b manifeat immediate ampwtatfawi maat be raaortad 
to. the limb being now in a state mors or lam dead 



IS4 



INTERNATIONAL ABSTRACT OF St'K(;KRY 



R. M.i Blood-rM Bifor* 

A9tk Iml UfJ . iQift. 



mm! coMitavtiac * to>^ ^^c** wUdi ■o jiilt nt 

OUMHT tWUI IMMVU COWi COW|Mf* ftWHliVt 

irmUMttt tamkttt fai oMtkodiedljr 

opcail^ M]f iMMMtOHMU Of tkt Moibt 

to « IciiM of dw larpr vHMb, Mdi biint ofui 
■Mfkad fai Ml iMldiow gttiM. Oiily failkb w»v aw 
tritsfiof coHttUcftUow* mdi m MCoodMy mmb* 
onWflit foltv uwwImHi Asd iwiv MOidsllsr thit 

WMf Wy of MCOSdw flMMMM lUMIMW Dt ftVofalsd. 

W A. 

TW autbon nftr to iht racent work of King 
Mid ITHBjif «ko IommI tiMU Um reoMival of the 
fplMB miluil ia Ml iacnMt la Uw toul (au and 
npoidi. Ml ktamm la cholMtiria, tad a dacraaae 
la dw atlaiind fatty ackb aa inifMaiirl bv the 
iodiat aaaibar. lo addtlkm h waa alao foond that 
ia itvcvt aa«nias there was a vrty high iodine 
aaadicr, MgfBBiinji that haai o iyii a in aannia waa 
la MNB* way iclaied lo iba aantaiatcd fatty adda. 

Dabia aad pMica, icocatiaf aoiae of the work. 
toaad tiMt oa aaalyrialmofo aad after ipleacctoay. 
of the blood of dop there waa pcactkally no change 
in the awiPim! of total fata and unaaturatcd fatty 
adda, aa oipmod bv tbe iodiae value. Tbcae 
iMahi M« aaauBMlMd aa foOowt: 



FAT 



AMD Arm 





.•^ 


l^pytttm 




DV 


fJSL 


£& 




tti 






• a 

It, 

f at 


*»1 
t* • 

41 * 

m 

«? 4 
W 1 


• 4S 

15. 


Ml 
•* 
II » 

49 4 


IMtev* 


•IteMB 


sat^ 


»«m«(l 


aaiatk^ 


Ltrj 


i3edMai»« 



C G. HcYo. 



G.t Tbo 
la 



la 
<*fr.. t«i6. 



Of cho 

(U 
opanilvO 
xahr. 711. 

Tbe aatbor boa abaodv jMbBabadmalu of bit 

hMh^ modMotioaa vt tbi TiloooiMaitciitf li to 
operative iatMwlioatk jbo piaiMt itady of 
coMabttioa la fapBlMMatal aad icfcnaco la Made 
to a fartbcr coatHbatloato tUa aaaw «ady BMde 
by aawal otbcr aatbon. 

Tbe raaahaoblaiaed abow that in a fairly coaalaat 
depoe tbcrr b a poMoperait\'e aiigawatatioa of tbe 
OMiaiatioa of tbe blood, whether tbe fattcrveatloa 
b aMde Oder ether narcoiiaoraot. Tbiaactdcratioe 




bat rMberioadato 
dl a ap peo r within a few dayt after 



Tbe urtbifT doM 



aot Mtoaipt to draw aay 
MiBifW to tbe fact of tbe coaetaacy 
a« "ft iadapoadMMly of 

W. 



of tbe 

tbe aaroiMlc 



^ G.t A New Method of Blood-Tmaa- 
ffailoa (Ua prac4d4 aouvvBa <fa iraaifaika da 
•aag). BmB. At*i. i$ mM, ^«r., 1916, bnrrl, atj. 

Blefbiaaaa poiaia out that the methoda of tiaaa- 
faaioa aow to vogoe rr<|uirc a clclicaqr of taatia- 
mentaiion and nuuiipulatioo wbicb are aot always 
obtainable under tbe conditiooa of war atufery. He 
has therefore eadeavoiad to fbd a awtbod wbkb 
would nudw blood<4saarfadoa a adaor operailoa. 
aa aiiaple aa totraveaooa fa^Jectloa. Hb pfooedaiv 
ia baaed oa tbeae priadpleo: 

I. Rapid with^waTof the venooa blood fioai 
the doaor toward tbe circulation of tbe radpicat by 
tbe appUcatloa of tbe pbyaical phratoBMBna of 
ajfpboaaafi 

}. Dilution of the blood to the tnuHfaaion 
apparatuft by artificial tenim. 

J. The principal part of the apparatoa to ooa- 
abt of a caoutcbooc tube, thia aobataaoe, Iflke 
paraffin, poMfing tbe property of retanUag tbe 
blood coagtttotioa. 

Tbe detaHa of coaatroctioa and tbo awde of 
application of the apparatoa are dcacribed. Caeca 
are dted to which the apparatus waa socceaalaOy 
used. W. A. 



Prlmroae. A..andRjcraoa.E.S.: ThoDlractTnuM- 
fualom of Blood. 3ril. if. 7. 1016. U. 384. 

The authors onphadae the great value of blood- 
traaaf tnioe to all caaca of toemorrhafe aad report 
foor caaea soooeeafullv treated by tranefudon 

Tkaarfadoa b tbe ideal tbcrapeutic aMaaara to aB 
caaea of baaiorrbaie. It iacreaaea tbe oooftdabOity 
of the blood aad iB4iffovca the local woJitanrii of tbe 
patient to infectloa. The improveawat to tbe 
tieat'a feaeral ooadbion and in the local 
b aeea evea to caaea which »how little or ao 
to the red-ceO ooaat, the introductioa of a 
coaoeatiatod blood f n««»«"g an nsmn ai i wUdi gwlffc 
ly reatorea tbe I 



Tbe apparatua iMod by tbe aatbon b very doMle. 
of two gbMa raaanlar witb rabbcr tinea 



Mtacbed, aad tea or bmw« ae-ccaL glaaa 
Tbb appanana b ateriHard by beM aad b 
coMed with liquid paraAa bv fbst dippiac tbe t 
er of tbe syringe into parafia aad taca drawiaf \ 
panl&a op into the ajfriafe tbroogb tbe caaaab 
aad tube. One r annuls with \x% attached tube b 
coaaected with the vein of the donor and tbe other 
witb tbe veto of the lecipieal. Tbe coapliag aad 
aaoottpling of the syringe b BMde at ita Jaactioo 
with the niblKT tube. The currenu of fww to tbe 
cannuir must be cooatant. normal saliae bdag 
aaed a b e ae v er there b aay detoy to traaafadag. 



GENERAL SURGERY - MISCELLANEOUS 



«5S 



The cues treated th omtd OMrked ii 
as well as pcnnaaaat ianrovancat and the dooor 
experienced Uule diacoauort, bdng able to ictnni 
lo duty after a ihort interval even when as mnch as 
I.OOO can. ci blood was taken. 

The vahw of transfusion in the cmofeodca of 
military sorfrry cannot be overestimated, as hcmor- 
rhafe b one of the chief causes of death, particularly 
in bullet wounds of the abdomen. J. W. TlTamca. 

BLOOD AND LYMPH VI88IL8 



HnbeesCt H« voo: 
). 



The AoeurteflM of War (Kikgs- 
Ank. /. Uim. tkir., 1916. cvU. 61 1. 

In an extensive article von Haberer sums up the 
remits of his experiences in the operative treatment 
of war aneurisms. He fives a collective report 
based on the indications and results obtained in 
bb total of 7' cases treated operativdy in the 
Reserve Hospital at Innsbruck. 

He divides his treatment of aneurisms into three 
periods. In the first he treated ij aneurisms by 
ligature with generally good results. In the second 
period he treated 39 anetirisms, 16 by ligature, and 
13 by suture — 5 lateral. 8 circular. In the third 
period he treated 30 aneurisms. 6 by ligature and 34 
oy suture — 7 lateral and 1 7 circular. 

The situation, treatment, and results in these 
73 cases are shown in the following table: 



i«ftW 




Taial 



Itakadof 



ii 



II 



•OMcwa 
•Omcw* 

Of the 5 cases with a fatal operative result 4 
were treated by ligature and i by suture. The 
results show that of 73 aneurisms operativdv 
treated, 5 died and 67 recovered. Of the recovered, 
a were snbaequently amputated, the other 6$ cases 
^ without mutilation. Von IJaberer 
that the correct treatment of every gunshot 
must be operative; and hb ea pcficn ce s 
lead him to the following conduskna: 

I. The ideal operation of every gnmhot innir 
ism b vascular suture. 

a. Vascular suture mav be executed mtKh oftcner 
than b feneraOy believed. 



3. Vascular sotvie maat aa a fOMral rale bt 
divular rather than lateral, hrciia lataral sotuie 
narrows the Inascn too OMidL «h«i tlMfv ate kifi 
Uteral dcfecu; and became there b also the neater 
danger of thromboab of the sutttred region eadaafer- 
ing the function of the suture. 

4. Suture b not indicated in very small arteries, 
in which ligature assures a collateral circulation. 

5. There will always be cases, particulariy in the 
large arteries, where ligature must be undertaken. 
Suture b excluded when there are extensive tissue 
defects, and especially in severe infection, the disap> 
pearance of which cannot be anticipated. 

6. Where ligature b neoesaary, the ligature must 
be made either within the sac, or dose to the sac, 
taking the utmost care of the cotlaterab. 

7. Aneurisms should be operated upon only 
in properly e(|uippcd hospitals, and if pirsaihfr 
not in the field hospitaL Trained asabtants 
and an experienced surgeon are necessary. It b 
obvious that when there are dangerous compli- 
cations such as hjrmorrhage or very serious in- 
fection, aneurisms must be operated upon imme- 
diately. 

8. The best time for an aneurum operation U 
between two and three weeks after the injury. 
During this time one b able to judge if a serious 
infection exists or not; and if this b evident there 
should be no further delay. 

9. Slight infections may occur weeks later and 
even after complete healing of the wound. Tbev 
do not forbid operation nor suture when indicated. 
In doubtful cases it b best to take the precantioa of 
draining for a few days. 

10. .\ll late operations are made unneoeeearfly 
difficult by the calltises resulting in the menntimc. 

11. For the same reason, procedures such as 
compression of the aneurism are more harmful 
than useful. They only cause c alluses and in- 
flammatory changes in the sac. 

13. In all gunsliot injuries in which the projectile 
in its passage has struck one of the larger vessels, 
judgment ^ to be most careful, bcosuse even 
wens later, when the patient moves around an 
aneurism may manifest itself. 

13. Infected aneurisms may simulate abaccssea, 
therefore the utmost care b advised in the examina- 
tion. 

14. Whereas in a successful vascular suture the 
patient can be treated aa r e c ove r e d after a month, 
thb b not the case in a ligature, because here slight 
disturbances of the drcuUtion remain for a conmd- 
erable time, which renders the man unfit for the 
heavy work at the front, especially in winter. 

15. The rcsulu of vein trannlantauoo in larger 
defecu of the arteries are very donbtluL 

16. The rtrength of a vasndar suture b e x tremely 
great, as b proved by the possibility of putting a 
simultaneooa fracture in exten sion immrdistdy 
after cfaadar suture. 

17. Aneurism followed by paralyib of tke 
b very frequent, not because of lesion of the 



i$6 



INTKRNATIONAL ABSTRACT OP SURGERY 



TlH 



•hot, bm 



oa acciNuii ol 




of tW It OpMBUd 

W. A. BaMMW. 



•I 

(OMBCMdTl 

Ian ftvtc 

»). Bm»,'Amd, 
i«t6. bsvl. tj^ 

TWrt an two typct of anorioyenoot Moiriimi. 
OM wiik ft Mcllw oUMT witlMmt, Tlw type withoat 
ft MC it v«y raft ft»d Ddbct ftod Mooonot, in js 
CftMi of mmrimm of the frmocal, od^ nmod ihit 
tjrpt tbo ttwMi SifkUy k b dm aa aaMii«B, bat 
raUHT a daiplt litvla Mtwoen the arteffv and vdo. 
Sack aa ofict b aoc wvaOy tW mult of a prittary 
htkm bot ocaua loaM day* or cvoa mmm weeks 
thm il, aad ia iJm ovtcooM of a poriaitoritia and 
by tbe giialer or Ion con* 
oftbeveaote. 
la ibo aotbor'a two caaeo be extirpated the inter- 
I oormpoodni to tbe 
pfooodod by ipndivple Hfatuie. 
W. A. Bbkxkak. 



Bonlay. J. S.: TWuaaMdc A Iwi of the T«ni« 

pond Artery. TV. Smilk. Smg. tr Cymtc. A$$., 
Wbiie Solpbor Hpri^i. 1916. Dec. 



Hoiriey caBa aHetioa to the infrequency of 
liHB wbich difen from tbe Kxalled 
rim of diMiied artcriea. A trau- 
aacttrkm ia caaied by a trauma in a previou a » 
bealiby veaMi, aad i«oJ|y resulu fron tbe or- 
of ft baoMOoaM wUcb it prodaoed by 
, UiaftBy wbea aa aitary is faijared tly 
Ibe patient either bleedi to death or tlie 



Miopa 
malic 



ft tmnaa, ibe patient either bleedi to death or tbe 
vmmI b ofrl ada ri by tbe ptfiun of the thromboa. 
WkH thi* dom not occur, a tnunuiiic aneurism 
■ay MOttlt from a pocket or lake that occurs in the 
dot wbcra tbe artery ia iajarad. Tbe roodhioae 
wUcb promote tbia amy coaibt of aome defideacy 
ia tbe elaamau of tbe Mood or timom that produce 
prnayl rlolthn. or amy bo merbaniral and icaalt 
from a lap of ladma bomf dotadrnd. or by prceaure 
of tiM bMaaloam caaiiBf aa eddy b the blood at 
tbiapolat. Tbe toaiporal artery bverveopcrfidal, 
•ad wilb ila tonafaml braadi, the aaterter temporal, 
ia aMKb oipeaed to truuaa. It baa bat little pro> 
lactioa hv aoft timae eitber above or bdow it. 
Skwe t8«o a latber tbwnajb oearcb of the literature 
baa altowa oaly ive caam of traaamtic aaeorism of 
tbe tempetal aitoiy aad ila bwacbm. To tbeee 
■1 Honloy adda caem of bia owa. 
Ia aritMr of Honley'a caem waa there aay evi- 
of aypUHi or other dieeaee of tbe arteriea. 



larpi 



tcflaporal ragioa 
ras imawdialdly 



rhtch 



paitiaBy abeorbed. 



bat leealtad la a aawll pulMting 

o a e b a W tocb b dbmater. operailoa waa 

after tbe iidanr aadar lotfbl ai^ 
■atbetic, tbe iac beiaf eadiad after tbe affteiWa ««a 
UfUed. Tbe eecoad caae waa b a yoai« boy. 
yoaia of age, with a eooMwbat efaaBar biiiory , who waa 
liMand wtte wmiling In tbb cam tbe aaaaibm 
fanrndb tbe temporal artery |aet above tbe ayiomft. 
It waaMdHdaaoerbcalaaaetbetlc. There waa ao 
recamace m dtlMr caee. 



(Vbm-uols 



l.4nif: 
Uiacure for Vaecubr 
de Igaiani pour bib 
i«i6, p. 401. 

Aawag twenty-three caam wliich were obeerved 
by the authon in two and ooe-iialf moatiM tlMt 
was one death, which occurred a few awimenli 
after liitature of the feraoml veb b Huater'a caaaL 
Autopsy showed numcrooa iafaicts in tbe right laaf. 
Three consecutive aaiptttatioDS were aeoemaiy. Oae 
amputatioo b a caae of ligature of tlw aaterotlbbl 
artery was due rather to tlie omsoui and articulatory 
injuries than to the eflecU of tbe Itxature. In a 
case of ligature of the popttieal veeaeU the circub* 
tkm not havins txrcn re eeleblhbrd. anpotation 
waa necessary three dajrs bter. The third ampvta- 
tioB waa done tluee days alter tbe ligature of tlie 
femoral artery aad vein in Hunter's canal, foUowod 
by gaseous suppuration. All three casm r e c ov er ed. 

In tbe 19 otoer casm tbe operatory after 
was good and no drcubtioe'troubba were 1 ' 

W.A. 



POISONS 



Mootais! 



Coocemli^ Tecai 
lalecttoo, Partfcubrty T 
Trismus (Sur le tctaaos post 
ticuUer ftur k telaaw sam 
PtsUiv, 1916, saa. No. 7. 




post senqam et ea par- 
liiawm). Amm.d4rhui, 



Mootab bdpe to dear up tbe subject of local 
tetanus verv nuUerially. He has collected ai casm 
from FreacB sourcm of well-defined local tetaaaa 
without trismus aad a number of other caam te 
wbich trismus su per v ea ed bter. All of tbe casm 
occurred in persons who bad recdved tbe pro> 
pbvlactic dose of serum by iajectioa. 

Mootab my* that the fbat cam of local tetanus 
was obe er ved in 101 j, and that the form of tetaaaa 
which bcfiaa bcaUy aad eads b trisans baa loac 
beea appradated. yet tbe form which b deejgnsnd 
aa local aow b a pathological oovdty, aad that it b 
tbeoalcoaMof 



I. Ia the fint groapL tbe tetaaaa reamlaa lo* 
calleed b tbe ngioa of tbe woaad, tbe poadao aad 
baftar cealan aeraplng ahogetbrr. Tbb ia, 
etiiclly m»eabiaii laeftl teiaaasftad it occun alamet 
eatfaaqr witbb tbe firet moatb after tbe propby- 
lactic doeage. Tbe bcubatiea amy be oaty a few 
<faqra af tenrard. but b oae cam It waa tbrm 1 
Only two of the reported caam died. 






GENERAL SURGERY — MISCELLANEOUS 



«$7 



3. In tbc Mcond gioap, moce fraqoeothr mi 
than the 6r>t, alUioagh local in iu ontet, Uiere b 
«r h fa m» Omt the higher centen are not complrtdy 
pratocUd, became after the Upee of days or weeks, 
trfaarae aad ocber feneral m^nptone appear, fre- 
qaetly of do great le w illy. TlMOMNtaUty at might 
be mppoaed b higher than in the first groap. 

3. la tlie third group the onset is usually from 
tbe oeooad nooth onward, the protection of the 
Iddbw ceMen b much lees. Trinnus, cervical 
ripcttty, and other of the well-known general syrop- 
tooe of tetanus are noted; the local onset in the 
injured member b no longer seen or at least it b no 
longer sufficiently present to attract attention. In 
thb group it would seem that there b yet some 
•light degree of immunity to modify the severity 
of the symptoms. The crbes are not so severe as 
found in one entirely unprotected and the spasticity 
■hows a tendency to persist. The mortality is 
fawn 33 to so per cent. 

4. In the fourth group there b no evidence of 
protection and the tetanus b of the ordinary type. 
Moatab states that tbe tetanus bacillus b found in 
spoaadi awislly in the form of spores, and these may 
germinate, liberating toxins up to many montlis 
after implantation. The dormant spores may be 
awakened long after the effect of the prof^ylaxb 
has disappeared. 

Why sbonld early tetanus in the protected man as- 
sume the local form? The answer b both ingenious 
and plaostble. It b generally understood that the 
centnd nervous system b invaded by the tetanus 
toxin by way of the peripheral terminations in the 
musdes, the channel being by way of the motor 
nerves. It b for thb reason that the involvement 
of the spinal centers corresponds to the site <^ the 
wooad. In the unprotected man simple local teta- 
aat practically never occurs. In him the centers 
in the poos and medulla are the first to be attacked 
becaaee they are more susceptible. Tbe route to 
the centers in the pons and medulla b a roundabout 
one, by way of the blood stream, unless the wound 
and focus of infection are situated adjacent to the 
cranial nerves. In the man who b protected, the 
hitler centers, beyond the spinal ones, are shielded 
by the antitoxin circulating in the blood, while the 
•pinal centers are immediately accessible to the 
toxin in the wound. Montab believes that early 
local tetanus b the result of immedbte and copious 
outpouring of toxin from the wound, at the same 
time that in protected man the higher centers are 
receiving protection from the antitoxin in the blood 
stream, otherwise the case would resolve itself into 
oae of the regular tvpe with a rapidly fatal issue. 
la the simple local forms of tetanus the mortality 
ii low becaaie the p rogao s b d ep ends upon whether 
or not the higher centers are attacked. Unless 
protection b kept up as already recommended, 
the shield afforded by the antitoxin gradually wears 
away, trismus and other general symptoms appear, 
aad the disease runs its customary coarse. 

L0CIS A. LAGAaoa. 



br lai 
(Tetaaos ches 

intra' 



aGMMOarstf 

nsri par b simhcnpie 

). rwt$M mSd.» i«i6, p. 4J3. 

A child, 8 jreais old, after a superficial thumb 
injury developed telaaas 00 1 he f ourt h day. Wit bin 
seven days 280 ccm. of antitetanic 
iojected in the veins; also 40 ccm. in the 
rachidian fluid, .\melioration did not take place 
until six days after treatment. From the sixth to 
ninth day of illness the child showed urticaria, 
fever, tachycaniia, cyanosis, etc After ameliora- 
tion set in it progressed rapidly and the child was 
completely cured within a month. 

W. A. Baami AST. 



SURGICAL D IAGWO SIS, PATHOLOGY, AND 
THERAPEUTICS 

Ochancr. E. H.: The Biochemistry of ToplaU 
AppUcatkMM, with Special Reference to the 
Use of Boric Add in Septic Infoctioas. Tr. 

South. Surg. frGyuu. An., White Sulphur Springs, 
1916, Dec. 

The laws governing the absorption of local 
applications to the skin have been tbe subject of 
considerable investigation and much controversy. 
Thb difficulty has been accentuated by tbe fact 
that until recently the laws governing osmosb and 
dial>'sls have not been imderstood, and have invari- 
ably been presented incorrectly even in special 
works on this subject. 

It has now been determined that osmosb b not 
dependent upon the semi- permeability of the 
membranes but upon tbe chemical affinity different 
substances have for each other. Thus, for instance, 
solid camphor will pass through a rubber dam if 
bisidphite of carbon b placed on the other side of 
the rubber dam, while it will not pass through if 
water b placed on the other side of the rubber; 
showing, conclusively, that the membrane aloae 
does not determine whether all substances wiU pass 
through or not. 

In the chemical laboratories huiKircds of exper- 
iments have been made to prove tbe correctness of 
the statement that chemical affinities aad aot the 
semi-permeability of tbe membranes detenaiae 
whether osmosb and dialysb will take place or aoC. 

Concentration of the solution b abo a very 
important determining factor. 

Clinically the laboratonr experiments can be 
duplicated by using sohitioos of boric add aad 
water as a wet dressing. Here again it has beea 
determined that concentration of sohitioo b of the 
utmost importance. A saturated solution of boric 
add when applied to the skin will invariably •ppcar 
in the urine in appreciable ouaatities withtn an 
an hour, and if a wet dressiac m kept in place for a 
coasiderable time the aasooat of boric add which 
appears in the urine Buy rise as high as two-teaths 
of oae per cent. These cheaiiral expcrimeats, as 
weO ss diaical experieaoes, prove rather 



>ss 



INTBRNATIONAL ABSTRACT OF St'RGKKY 



oi drnvov pstlMpMlc 
iMr ytfilMci m hm 



tMfy iImi b ofdir to bt d hcd in boric add muM 
be mtiH in MUvraltd 
WbUc bock odd 

amAf biiiidiaoMinMd by l«|Ktiaf poo, 
bdrowo liMo Mpck li l o cti oM, iMo i«M oamob 
bffoio ood offer ibt opfdlcotJos of boric odd di«io> 
Ingik If ihr im» b A^niird before ibe boric odd 
bAft breo UM<d. it will kill tbe Int onimal to 
OOillirt qu«nliti» thoo I Hal whirh boo 
olirr the 4nhImi bAVr brrn 
ohboogb ordiaorily potbofMic boctcrio become oMiro 
vindeot by bda| ponod iWiWib o bumoa boat. 

llie dnicol oi^Mimoai bovt obo doMOMiroied 
ibAi «•! dvadap of boric odd oiv mucb more 
oflectivT in Mreplococaa MopbylococaM olbiit oad 
dlfOM ibAo in aoy oiber type oif iafoctioo. 

la order, bowever, ibot boric odd moy itocb its 
ouidaMm of cfkieocy, MNoe otbcr difoctJOM tbould 
be iilioii loil ODcb as: aheolutr reel la bed; proper 
oiicolloa to cMminatkm by the laap, ikia, bowels, 
oad Udacyt; relief of poin. if poaible wiiboot the 
•ie of opMrteo, by tbe odditioo of from to to jj 

Cecal of OS per cent akobol to tbe Milutioo. paint • 
tbe ialiiaiil area with qs per cmt rarboUc acid 
aalfl il tWBO wbite oad then rrmo\-inK the occio 
carboHc add witb alcoboli elevation o< the exlicm> 
itjr with the moodo wuioaad ing the iovolyed joiot 



It b Impoiiiblo to aay wbeiber okbor or bocb of 
Ibo iloado wbkb abow rbii^M la idlpodi ddoiMo. 



at equilibrium; laddoa oa|y when there la BMcro> 
•oopic ovidaaoe of pat aad aflor a certaia dcgioo of 
iiaiBBailj bai ih iilinifrt If lacWoa becoawo aecco- 



•ory 



hondagf aboald fim be applied 
tbea tbe iadaed wound 
•boald bo ovabbod witb tincture of iodiae before 
lo iwaofvod, and tbe port tbould be 
M Hide 00 poMMo. If all of tbcM 
are o l »ei ycd MpUonaia, pyvmia. and 
of fttoctioo will rarriy if ever occur. 



J. L.t 



of llM Wipop li j ^l a to Or- 

the Th«ra> 
illoa of lea Kstrocto. Aat. J. M. 
S40- 

of tbe aatorior lobe of the 
la 



doalb, poftiil reoioval in 
■coo. Tbewpriiit Jrally octjyo 
labotaacc ia pnoeat oaly fai tbo mis fattcnaedia of 
tbe poMcrior lobe, aad ofhda tbo cardiovaocalar 
Meoi. tbe kidaey. aloiao. ariaaiy bladdor, 
twe. and ibo MotUoa of tbo awaoaa 
It b tbo pail ill ooapiod view ibi 
la doe to iiiwfaanhiaii^ of tbo aatorior lobo of 
tbe bypop l ^ y ri a. Dyotrapbia odlppiMiainlli ia 
oO probiMliy la doe to tbo aalorfor lobo olw, tbo 
"Mce boh^ farahhBrI ty tbo 
oa doo. la wbora, vbm a 



Mo poftloa of tbe aatorior lobo la 
tbe rroelich »yndroaK of dalayod dumi op- 
o^pority. aad failore of ocnol dovdop- 
Hiaaiool of tbo pootorlor lobo baot followed 
by a^y oerioaa coaioqB«on. Onoaotberopy ia 
tab coaditioa boo aot ghw yoqr dolaiie icoolta. 





tbe thyroid, aad tbo bypopbyih, an 
for tbat ceatttlloa. 

Tbt oadiayor bat boea BMMb to espiaia bypopby- 
•Ml dfebotoi ladpidao oa the rrMilt of ovor* 
octhrity of tbo aoolorlor lobo. but there b ao vory 
dear<at aaiaMl oaporin 
ofterponialoft 
boa brr- 

Tbo m*» ofllvo oyidoBco' tbat tbo 

whoa oiaociated witb liypopbydi, b doe to 1 
ratbor tboa to l acr eiio a tociotioa b furaiabod by 
clinical oboervatiooo. aeyeral worben baviaf dMnra 
tbat the sabcataaoooa iajectioo of extracu of tbo 
poaterior lobe will Iciaoa the urinary ootpot 50 
per cent or aioro. Tbo author waa aevor able to 
demonstrate by onoriMoott on both aonaol aad 
nephritic individaab, tbat {Mtuitrtn poeaeiMd oay 
diuretic artioo. 

It b generally coaceded tbat notieau witb 
acnMBefBly very freoaoatly abow euber a traad- 
tory or penaoaeat vyooaoria. bat tbe "^^^kn^ 
raulta of tbe experimental effects to pro da co 
glycoauria in animab and the ladi of coaataacy of 
the dinical obaervatiooa, make it appoioatfar impoa- 
sible to determine tbe rAle of the by pop ^yab in 
sugar metaboliam. 

It baa beea abown that while tbe falactoaofBO 
action of tbe bypophyo i i> wbicb b prwit oaqr la 
tbe poaterior kibe, prodtioeo aa inrwooa la tbo 
quantity and tbe otuiUty of the milk, yet tbere b a 
neductioo bdow tne normal at tbe next —a^**^, 
so tbal the total output and the (at corrteat b aot 
increoaed (or tbe twenty-four hours. Aa iauaoaily 
b abo rapidly acquired alter iu prolonand aoo. 

It b impoiiibli to sav whether aay of tbe dactli 



latmyoaottsly. pittdtiia coaeea a 
looaed rise in blood-pwawra witb 
of tbe heart; oa tbe ateraait ilbaalalfli( 
by iu direct actloa oa tbo anairktod bwcIi, fai 
properiv selected coaca its aae bdag kflriy fm 
from daager. Oa tbe iateatiae, poatenor 
oxtffKta come fint a loneaiM of tbo toaaa 
porinaltk actioa, oooa foUowoJ by 
aad perirtabb Iu aae bos beea rwio a i a iendo d for 
postoperatlyo pcritoaitls, la laild latcotlaal obatrac> 
tioa, aad la poatoperative intestinal stada. Tba 
aotbor baa lasea ao beaefit ia iu iatraaiaacaiar iho 
ia tbeabdoadaal diatoatioaof paeaaioaia. 

Favorabk nporu bayo appeared oa tbo aaa of 
pituiirin in caadag fpoataaaoas iaytyiag of tbo 
bladder, tbas ayoidfait catbeterbaltoa after 
faeaMat aad after operatJoa oa tbe pchrk 

Pbaltria May bo of yahw ia coatiaOiac i 
^ ' . . tr;wbikitlii 



r of a oertala cbaiacter ; 

ia aooe aad tbroat opera- 
lioaa, ia tbe tnatOMat of ptdaaoaafy bMMRaafls, 
aad ia tbe radactloa of tbe roofahtliwi tbaa of tbo 
SboaM pituitrin prove to be a h«aoautk it 



GENERAL SURGERY — MISCELLANEOUS 



IS9 



k 



will ptobftbly be Umwfh its foifwlatim ntber than 
iu vaaooooMfkUir actioq. 

The above ranilu aie ohtainiid only through the 
lue 9i poMerior lobe eitracts given »ubcutaiiMualy. 
intravenoaaly, or intramuiauarly. but not when 
given by mouth. Evidence h Mill lacking that 
anterior lobe extract b of value in MimtUating 
growth and sexual activity. E. K. AnitSTBONo. 

BZPERIMFlfTAL SURGBKT AND SUSGICAL 
AlfATOMY 

Maaa, P. C: A FurthM- Scudy ol the Gnairlc 
Ulcere Following AdraonlectMny. J. Exp. 
Med., 1916. xiiv. iJ9. 

In a previous »tutly of adrenalectmniaed animalfc 
the frequent occurrence of acute ulceration of the 
■aatiic mucoaa and the occaaional occurrence of 
miodenal ulcer were noted by the author. While 
tlMae vkefs were not found in adrenalectoniaed 
««»t— u nibjectcd to continuous etherixation and 
were infrequent in aninult subjected to the removal 
of od^ one gland, they occurred in about 90 per cent 
of tboae dying under the characteristic symptoms of 
adrenal insnmdeocy after the removal of both 
glands. The ulcers developed during the moribund 
period were apparently peptic, forming at the site 
of the local hemorrhages in the gastric mucosa, 
and were true acute ulcers, usually penetrating to 
the nrascnlaris mucosa, with a total loss of epitheli- 
um. While they occurred in the absence of pan- 
Cfeatk secretion and bile, they appeared to develop 
only in an add medium. 

In order to determine whether the acid medium 
was the important factor in the production of the 
acute ulcers, or whether their cause resided in other 
factors, such as the special nerve or vascular mech- 
of the stomach, the following experiments 
performed: 

I. A loop of the first part of the jejunum, varying 
in length from 6 to 1 2 cm., was functionally resected 
under anithcila and implanted in the posterior 
wall of the stomach in the region of the antrum 
pylori. The continuity of the intestine was main- 
tained by an intestinal anastomosis. 

In four of these animals, after a considerable 
length of time had dapsed, the right adrenal was 
removed, and a few months later the left gland was 
extirpated. All de v elope d the typical symptoms 
of sdrenal ***— «<'^«'*— *T r and died at various times 
after the removal of the last gland. 

In all these snimab definite lesions of the gastric 
■ncoaa were found at autopsy. In three, there were 
vkeiations, while in one the mucosa was injected 
mkf and showed areas of erosion. In three the 
Jejunal transplant appeared exactly similar to the 
OMttroL In one there appeared to be a slight loss 
mucosa in pin-point areas, which mkro- 
, proved to be snoall ulcers, 
author hoped that these experiments would 
prove whether free addity was the primary cause in 
the formation of these ulcers, or whether the 



primary cauat Baa in the intrinsic mirhawism of 
the gastric mucosa. The results of the experiments 
show that both factors are of importance. In the 
three experiments in which the gastric mucoaa 
alone was involved, the transplant having been idl 
intact, dther the ulcerations and eroaioos were doe 
to a primary impairment of the gastric mucoaa to 
which the jejunal mucosa was not subjected, or the 
addity developed within the gland tubules and 

Croduced its destructive action there first. If the 
ttter is true, the jejunal mucosa might become 
involved afterward. The experiment in which the 
transplanted mucosa was involved might be inter- 
preted in this way, the author states. The cvidcnco 
tends to show that the addity is but a secoodaiy, 
although necessary factor, and that the primary cause 
lies in the intrinsic mechanism of the gastric mucosa. 
However, the fact that changes in the jejunal 
mucosa occurred in one experiment shows the 
importance of acidity. 

The author finally concludes that acute gastric 
lUcers are found in a large percentafe of ■nim^jy 
dying from acute adrenal insufficiency. In dogs 
in which a portion of the jejunum had been trans- 
planted some time previous to the removal of the 
adrenals, the gastric mucosa showed nx>re marked 
changes than the transplanted jejunal mucosa. 
This tends to show, he believes, thst the gastric 
juice as the cause of the ulcer is but a secondary 
although necessary factor. Gsonoa E. Bulsy. 

Alllaon. N. and Flabcr, R. F.: ExpcrlnicaCnl Booe 
TubcrculoaU. Am. J. Ortk. Hmrg., 1916, xiv, 6jt. 



In their forty experiments the authors ( 
foci of tuberculosis in various regions of the bones of 
young dogs. The cpiph>'sis and diaphysis of the 
femur, the knee-joint, and the subperiosteal bone of 
the femur and tiliia were chosen. Virulent human 
and bovine bacilli grown on givcerine agar media 
were used: 11 were epiphys^, 6 diaphyseal, 19 
subperiosteal, and 4 joint surface inoculations. 

From their experiments the authors oondude that 
it is possible to establish experimental fod of 
tuberculosb in any region of the bones of does. 
Their sections show growing fod in the epiphjriis, 
in the metaphysis, in the diaphysis, in the cortex of 
the shaft, and on the joint surfaces. 

They observed no essential difference in the re- 
action of tissues to the human or bovine t)-pe of 
organism. They found that where there were 
elonents that lent th emselv e s readily to new bone 
fonnaiion, the tuberculous process was characterised 
not only by bone formation but also by a reaction of 
proliferation resulting in upbuilding of new bone. 
The latter observation was bsscd upon the behavior 
of the periosteum and subperiosteal layers of bone 
in the experiments whcare the focus was Jmplantod 
in the diaphysis or under the periosteum. In tiM 
experiments where the epiphysis or Joint surfaces 
were inocuUted thb r«action did not occur for the 
reason that in these regiotts the proliferative de- 
ments are not found. 



i«e 



INTBRNATIONAL ABSTRACT OP SURGERY 



TW 

of bos0 praHlffsl 



btlifVt tiMt tlHVt k M 

m U» wcOwM tot 



fed 



tlMt li iW biiar tW 
ioB pbQTt M iwpoqart rMt. 

Lcfm 



0OWtfc» Of MfUHMHC Mriod* 

U) piffed «f dtdlM. Tk«t| 



\ A. M.I TiM lalMi P«rto4 la Hm Orawiii 
iMtwto. y. C*^ i/W . i«tft. uiv. il7. 

ClMMwy dMdH tkt Ife cydt of a Ucttckl 
aUittfv, M dtlHtalMd by wdaoUoot of the narobrr 
of vidbit onufeat mombI at vorioiu inirrvaU. 
Imo (oor ponodi or pMMi. vWdi, in tho order oi 
Ihrit AfipconuKO, iNqr bo iloiignncd: (i) the 

of ■orimiim nio o( 

! ponod* uy ilotioMfy po fi od» 

Ttat pSmh Mtrir Into ooe 

ft mup dmdtac i>«> ^n*! t^' 

vBfko Willi Mtnat 9ia« of 

with the 

of cnltoio 
oad MiB ocWr fectoiB. 
Bf kuoftt porfod or lac b meant the interval 
whidl dapOH btCwoen the lime oi Mnlinx and the 
tiao at wMcb aaiimuni nte of growth bcgiiM. 
Diriag tMa liaM tbcre may be slow growth, no 
■rowtK or aa actaal diininutioo of viabia offgaiiitau. 
Kb tbo pnooBt Da|>er the autbor daab with the 
■atore aad ilplirafo of tbk pboMOMaoa. 

Ha advaacaa oavnal vfawt to aqjilaift tbo natora 
of lag. Tba fact Ibat bactaila, wbaa Inoculated 
iMo loitibh Mttfitivo ftiadJa. do aoc immcdiatdy 
at tba BMifaMiai lato of wbkb tbcy are 
h» #ft ^tt tbat tbart la a lack of ctMnplato 
Wt wo m tba bactarial call aatf iu 
aad tbat tbia dtenapancy onist firM 
ba comctad before rapid growth caa cnaoa. Oovi* 
OMiy. oaa of two factore, oeU or awdlttBL mmaft ba 
at fealt. It foOowt tbat fai order tbat bacterium 
aad Botritive OMdium mmar baoooM completely 
adN"d to oae another a chaafe Mait take place 
laoaeorbotbof thefactofe^ Lag, tboa, tba aatbor 
tba time nrnweery for 
acaoantor 

tba poeribia 
■dor two biedi. 
or tba bactarial 

Tba aatbor 

caK. 




jaocolafioe b W0 
rate; il, however, tba 
rapid aio tba 
laiieac period bat 
rate aa tbat of tba 

UbiotbcaitanB'of 
at tba boftaafaig of tba period of 
giwwtb, tie bacteria laaMlalag faitba 



bfolboibibii 

tba caitara aeod for 

at Its maximaai 

iapowiiVat its 

Mbculture. tbov 

10 Biltl|ily at the aai 




at a rapid ratv uiwn : 

mm^mmmmmmU; If. bOWOVOr, the CUllUrT lo COalt 

at tba aad of tba period of Bmiimiim rata of gtvwtto. 
tboea bacteria wblch iMMda la ibe eoparaataat 

llttid abow 
many 



bacteria wblca loaMBB la Ibe eapanMiaat 
bow a paawMH lalaiM pviod* darfag wUca 
ol the ofgaafaaH dfe. Wble Ibe death of 
bacteria la taklag phoi tba paaoeei faOowt 



cleeriy the law of 

Actively giwwiaa paaaaMOoeri laocaUted lato 
tbo ewpetaataat laid noai a feat day calture ol the 
•aoM etrala ciMUlaaa lo grow npMly for ao appr^ 
dabia tioM after laocalattoa. 

Flltratca from 24 -boor cuhorH of naeaaiOBeccae 
inhibit the further growth of adlvrily gvpalag 
pacumococd when the Utter are Inocalatod lato 
mcb ftliralca. This inhibitory actioo of the &1> 
tratcs b lo«t in part, aa the caltaro flora wbkb 
the filtrate it obtaliiad la aPowad lo faKabata 

Actively growiag pocoaMoocci, after cipoetuv at 
low temperature* to the action of tbe fitrata of a 
34-hour broth culture of the raaM itrala, ibow a 
greater lax than the cootroU. 

The forrxuinx facta, the author ooariden, ofler 
•troog support for the view tbat lag la aa t 
of inrary whirh the bacterial ceO baa 
from its previous envirooaMOt. 

GaoaoB B. 

RADIOLOGY 

Johna. M. W.: Poatoperativ* X-Ray TraatflMOC la 
Mallgnanc Growtba, llaa it JarahHahod Ira 
Value? Imlma. il. J., 1916, aiiii. 14J. 



In the treatment of mpefffc ial tw a d l lhwie tba 
roentgen ray* have beoooM aa litabllriMd fact aad 
while than are nraasr olber met bode tbat amy ghra 
good reaalla, aoaa mw eqaalad tbaok Piney b 
quoted as havina treated 44 caaea of 
lip which were followed up after tbrea 
only two (attaraCk In the treatment of 
where oparatloa baa failr<l. or thoae 
pamed tbe operative staxe. while petarai 
are rare c onal d erah le relief was 0««a» aad fe aaoM 
tbe cnaditina faap rove d to aadi aa aiteot tbat 




Jobaa niviewataeaclfaa of tbe toft and hard ray* 
t tba coadarioa tbat (1) the X-ray ecu 
with xreater selective actloa apoa 
malignant tissue with it* rapbfly foiariag 
vriopii^ cclb aad blued varaeh; (t) it b 
actiwe apoa tbe older cela of tbe growth wfaicb bavo 
pcnbteo for eoara tbaa aad ' 
Usbed: Cs) nuilcal raaMval of tbe 



BMM| If paraiUa^ faBoaad by tbaraaga laylag of 
tba BMra raoeal caacarcrih aad lypbaifca, aril 
M upji i m diteila raealla fe tbe ihoiieet epace of 
tiara. Tbraa facia ara Waairated by tbe dtatloa 



lauof 
1 



facia ara Maimtad by tbe dtatloa 
I aad qaaialloBe from varfam* aotbors. Tba 
belhwee Ibal tbe aew CooUdge lobe tech- 
nique ba* greatly wideaed tbe ield of t 

W.S. " 



GENERAL SURGERY — MISCELLANEOUS 



i6i 



ILt lUndti of 
teHfirRaMili 

4'«ip«li«M0 NT k 



didfa i- 

09 CMRV)« 



Diicniifaif the qucstioo m to whether it ii prefer- 
able to hoiTt reooone to radMogv or radkMcopy in 
cctOcs the 



the locaHsstioo of projectiles 
that radioecopy ia preferable 



\ 



author tmnka 
for the foUowinf 



I. Its nMter rapidity. 

a. Raooooopy allowt the determination of the 
depth of the mrojectile being demonstrated on the 
patient hinseu; also the marking of the fim^tng* on 
the alia without having reooone to cakolationt 
or eoBMructions which can be done only at the end 
of the day when from to to ao patients have been 
examined. 

3. Radioscopy permits change of the base of 
search when it n per cei ved that another ia preferable 
oa nocoont of the situation of the projectile. 

4. Radioecopy guides the surgeon even when the 

Klient is 00 the operating table in the operating 
e to be selected; and even in the course of the 
operation if the finding of the projectile offers any 

5. There are no projectiles discoverable by radiog* 
raphy which cannot be discerned radioacopically, 
with a proper installation. 

The author's experience is that most operators 
who in the beginning used radiography have now 
adopted radioscopy. In the bcynning of the war 
experience of the working of radiolo^c installations 
was lacking Many were of the opinion that high 
intearities of 1 5 to 20 miUiampercs were necessary. 
It was not known then that radioscopy would be 
mudi more used than radiography. Now most 
of the radiologic automobiles work with a medium 
tetOMity and employ Chaband tubes, and even in 
i»d iastaHatioos radiographs a^ made with 3 
or 4 mJIHnmperes of current at most. The heavier 
can de vel op i ng 30 to 40 horsepower which were 
installed in the early part of the war arc therefore 
BO longer necessary. W. A. BaxMMAM. 

Childa, 8. B.: The Present Stanao of 
Therapy. CoU. M«d., 1916, xiti, 194. 

The results of roentgen therapy, especially of 
deep seated lesions, have been materially improved 
since the advent of better apfMuatus and technique. 
The three factors contributing most to the improve* 
ment are the CooUdge tube, the use of ray filten to 
protect the skin, and the "cross-fire" method to 
ncresse the dosage. 

From a review of the literature and from his own 
experience the author freb that the following coo- 
elusions are warranted: 

I. In the treatment of superficial epithelioma ta. 
the roentgen ray can effect a permanent cure in 
more than 05 per cent of the cases, and the resulu 
obtained are from a cosmetic staadpoint superior 
to those obtained by any other method of treat- 
ment. 



a. In leukemia and Uodgkin's diimsc a qrmplo- 
matic cure b greatly enhinced by the nae of deep 
roentgen therapy. 

3. In uterine hsmorrhage. in carefully idectsd 
cases, a cure can be expected in over 05 per cest. 
At present, however, deep roentgen therapy seems 
indicated chiefly in the treatment of utenne hem- 
orrhage in those cases where an operation b unde- 
sirable. 

4. In Graves' and Basedow's disease we have in 
roentgen therapy a remedy wliich can relieve 
comparatively earlv the alarming symptoms in 
many cases, snd if an operation is later deemed 
necessary the patient will be in better condition to 
Boccesrfully stand it. 

$. Ail operable deep-seated cancers, with adja- 
cent lymphatic glands, should be thoroughly re- 
moved surgically, and an area wide of the entire 
locality should be treated by the most approved 
methods of radiotherapy as soon after the operation 
as possible and as thoroughly as though the diseaae 
still exbted. From the results alrea^ reported ia 
the treatment of deep-seated cancers, postoperative 
radiotherapy can be depended upon to diminbh 
materially the present nigh percentage of recur- 
rences. 

6. All patients with inoperable cancer should 
have the benefit of radiotherapy, supplemented by 
electrocoagulation in cases suitable therefor. \\- 
though a permanent cure b not to be ex|jected, 
experience has proved that many brilliant sympto- 
matic cures have resulted, and many perMns have 
been restored to a life of usefulness and comfort 
for years, who otherwise were doomed to an early 
death. Furthermore, in the cases in which s 
symptomatic cure has not been established the 
patient has been relieved of pain; foul-smelliag 
discharges have been lessened to a marked dqpos; 
and the general condition has been greatly im- 
proved. It seems within the bounds of safe predic- 
tion that with a greater experience in roentgn 
therapy in thb class of cases, results that now se«B 
impossible may be expected. Aoolth IlAXTtmo. 

Mayo, C. H.: An Appradntkia of the Roea 
Ray and a Warning aa to lea Use In 

Ptagnoais. Am. J. Rtfrntgrn^., 1916. tii. 474 

Brief mention b made of the various uses to 
which the roentgen ray has been put in a «*^g~**- 
tic way and the value or harm resulting from the 
interpretation of iu findings The auUMir maia- 
taias that the treatment of certain fractaves has 
been almost revolutionised by early tfiignnais aad 
aid in adjustment incident to the use of the rasalfM 
rsy. Faulty interpretations of bone lesioas have 
been re sp o mib l e for sdvistng too radical operatioaa. 
By levealiiM the location of fofciga bodka, it has 
sbowa wiMcJier ioffefy Is iadicatod aad, vhaa Booas- 
larv, pro venting over-extcaslvc dinsctioa. 

In sa^ diiease of the laap as iht mdf stages of 
tobercakMis, fibrosis, local hfonrysffsrfi. aad cavi- 
tatioas, the roeatjsa fWsgnosii b amee sate sod defi- 



i6a 



INTERNATIONAL ABSTRACT OP SUR(;KKV 



aite ikM by pvrriow dalod 



Sipoiitaf 



fotWafaitlM 
timufy 



Pltorml 

or ipKlia Im. 

nyafsmbi ibt 

«ltbtliia|i 

• primary or 

vbM ifit Mm Imm pmnntd 



toilM 

U diMMt of tW fuuo4aiMliMl tract it Mt 
oaly nad qi imy C itato aad paA ifaald la diaf- 

trauaMM l a qp ta al N ot Jalioqaaatly it laadara 

lag tlw lanpMahWiy of tW iMtaa. In «n estmndy 
U||i panMtaBi of comb daodaaal ulova taa bo 
<HapMtad bylta aid. lataMiaal iuaK>n, duoalc 
"' ' ' ' ibov rwnarltihly 

la a laifi OMjority of 
aad coloo 




ptorfB caa bt ikoara with the X-ray iMa doot ooBikl- 



aiablt hana ia Itading to tiudvitabla tariery by 

ich 



ailnenu to tbia coodltioa, whi< 
■ay baladdtatai rather ibaacaiiiallfi. 

TItt rocoiflco riy offer* gmt aid la the itiignnrii 
of dbnat of the kidaey* and urrtcrt. The prtnaca 
aad lacatioa of atoaat caa often be shown aad the 
laoagaitioa of andtipla calcaU aadoobicdly Icvea* 
taa pdvaatafi of tappoeed ramrreoccsw Deform* 
itka of the pchrb of the kidney caa be outlined bv 
the py jog rim . that OMkiac poiribic early diignodt 
aad opoatioa of hypetaephiwaa. 

Tha ate of the roeatfea rav la rholriit Merit or 
cho le tyM ltk iaroaridtml by tae author of conpar- 
athrdv HttJa vahM, tendlnt BMialy to corrobonte 
the dtaical Jadian la mom of tha gmcs ntbcr than 



faryihii^ rtiipnailitile ^■Ti firT ****!***** 

As a aaaaa of locatiaf fad oTlafoctloa at the 
apicae of tha taeth, the lontfea ray raperaedci all 

la co a d i i rioa tha aathor ornt the roeataeaologitt 
to ha brief, comIm, aad f raak ia maklaf fab laport 
of iadtapi TW interpreutioa of thcee •hould be 
pwp w ly cnnalatcd with laboratory and dlaical 
teau aad adllelia hiiioriee to that the gioateet 
profkkacy ii diaical diagaorii auy be obtained. 

Aaotra HAKmao. 



w. II 
IVanied »1ih 



J. Am. ImtL 



49OL 



Pacleaia 
Raya aad 
After More Hum 
Btmmp., 1916. ix. 



laports 16 caaes: 9 treated with 
oaa with X-ray alooe, 5 with mnrry 
with X-ray and radium. 
Tha tioM of obMrrallea napi fioai J to i> yeara 
frooi tha bifiMrfat of tiaal— il aritfa gaod raeaiu 
hi thoaa aipartad. 



of the Jaw, 
of thebhiaT 



of thaataraa, 
of the ractaai. 
of thehbdder, 




(act that a mach greater aumhar of racanoai aad 
tavadaal caa« treated by hte hava '"'"nkH 
thaa have heat caiad. He ama poeiopeniri^ 
radiatiao for mailgaaary hi the pravaatiaa of 
tiaMplaatatJoo, l aa if iaaca, aad amaeiaeli Co- 



aia at pniMt 
aMtically pom 



achhrva batter 
•ecarad by aay ooe OMthod dog 



Caol It 



the paab, 
ara of the 



R. Il.i What Ifldeact lleve We of tbo 
Value of Fro-oper a tifo Roewijen TrealaMBt 
of Qaaeer? J. Awt, turn, a^mmp., i«i6. Is, 417. 

Stavaaa laporu j caiei of caaow of 

braaet, aad 1 caaoer of the uterus la which X-ray 
was used la the treatment. In only 00a was X*ray 
used previous to operatioo aad thea tha 
was performed as tae caacer of the peals BOW 
with the X-ray treatmeat. In the otheia X-ray 
treatment gave good lesulu dthcr withoat opera- 
tioo or in reotrraaco (oOowiag opoatioa. Tha 
cases were all reported befoia aay l«Mth of tUaa 
had ebpeed aad as Steveaa says: "WhatlteiMi 
verdict will be la these cases Ubm aloaa wfl taR." 
He coiidadw that the X-ray pmpaly used with 
good OMidem tcchniaue acconpUihea favorable 
results la caaoer which have not 
coa eh lersd possible. Cabl R. 

Buma, J. E.: The Uee of Thorium la 



Roewtgtenology. Am 



Thorium la Urelagy aad 
J. Rcttutrmtl., IQ16, ffl. 48J. 



with the 



After many experimental invcstigatioas as to its 
phannacologic action aad much dinical evidence 
alter a year's eaperieace ia Its use, the author has 
come to the ooadasioa that thoriimi possssssa all 
the ooalifteatioos Beosssary (or use as a pyalo 
grapUc agent. It b aoa-toslc, aoa-irritatlag. 
Quite opaque to the roealgea ray, poescasm amrfced 
fluidity, permitting its rmdy cecape from the uri* 
nary tract, docs not stain things with which it comes 
ia cootact, aad b iaaipeariva. 

The sdutloQ of dkoioe was foaad to be the doobb 
dtrate of sodium and thoriua^ together with an 
eaoem of sodium dtrate aad soow sodium nitrate. 
Tids solutJoo b oot bacteriddd and BMMdds graar ia 
it upoa standing; therefore. It must bo iladted 
aad kept sterile while bdag used. For pvabnuaa, 
a sdatioa cootainiiig 1$ per cent of ihontna la iW 
form noted ahoald be used, aad (or cystagBuaa a 
lo par caat s o luti o n has beeafouadeatlraly a i tbl a c » 
lory: 5 to isocuhic centlmetara have twcn used (or 
the former aad jo to gjo cubic osntimetcri for the 
latter. 

Regarding Us amthod of latrodactien ialo the 
reaal pdvb aad urstar^ tha gmvi ty awth od b the 

suooaaafuL ThaSoriom tdutioa was used la thb 
way hi soo caaea ia the Urological Clafc of Jokaa 
Hopkias Haipilal adthaot aay uatowavd 
other thaa could ha acceuaiod for by tha 
iastruaanlation or other aatiaaeous (actor*. 



GENERAL SURGERY — MISCELLANEOUS 



163 



Inasmuch as the thorium toluttoo ^ 

Marked advantafcs over aogr oUmt MlutioQ used for 
pyelography, the author cwM J ikw that lu great 
value in unilogy aod roeotfeoology has been (tiUy 
e»taUuhed. Adoltm llAartTMc 



three hours before the barium Utjoctkm. An or> 
diaaiy rectal tube b oaed. Inert ed Jwl past the 
spUncter. The enema coo^bts of a warm mixture 
01 barium and gum tngaainth. Bcfoce iniectiaf 
thb the abdomen is examined fluoroicopkally for 



L. L.: Routine Technique c4 Barium Dtag- 
Am. J. #(<M-N/ffaW^ igto. iii. 477. 

A detailed drsrriptioo of the routine method of 
roentgen eaamination in gastro-intcstiiud cases as 
practiced at the Hattle Creek Sanitarium b given by 
the author. In view of the fact that it has given 
highly satisfactory results in over 8.000 cases it b 
recommended as a standard technique to fadlitate 
comparison of findings obtained by different opera- 
tors and thus advance scientific progres s in this 
ibid of medicine. 

Barium sulphate U the contrasting mr<lium of 
choice inasmuch as it answers all tlie requirements 
as regards opadtv and has none of the disadvantages 
of the various bismuth salts which are acted upon 
by the gastric juice or various putrefaction products 
which may be present in the intestine. One- 
fourth ounce of the above is first given in one-third 
jdass of water, the patient being in the erect position. 
Thb b watched as it enters the stomach and passes 
into the duodenum. Following this, an ounce of 
barium b given in a glass of hot malted nuts and 
aiKMher ounce in a nass of oriental clotted milk, 
making a total meal of about one pint. The stomach 
b then watched for peristaltic waves, spastic indraw- 
ings, etc. The patient b then placed on hb right 
side on the horizontal table; pressure is made on 
the greater curvature toward the pylorus and the 
patient quickly turned on his back. Thb permits 
detailed examination of the tUle<i antrum and duo- 
denal bulb. Four and one-half hours Uter the 
stomach b examined for residue. If any b present 
its amount b estinuted. .\ 6-hour limit of normal 
empt>'ing is set. .\no(her observation b made 
Q.5 hours after the first meal to estimate the amotint 
of ileac stasis. Twenty-six hours after the meal the 
patient b re-examined to determine conditions in 
the colon, and at so hours again to furnish data on 
colonic stasis. If comideraue residue still b found 
farther observations are made at 74 or even 98 
hoars. 

As regards the gix-ing of cathartics or enemas pre- 
liminary to the above examination, thb b inter- 
dicted with the view of obtaining as neariy natural 
conditions at the time of observation as b possible. 
The patient b instructed to take no food or drink 
immedbtdy preceding the opaque meal nor for 
several hours afterward until the stomach b emptied 
of thb meaL No laxatives nor enemas are to be 
given until all observations on the meal are com- 




poasiblo rwlduM in the appendix or divert! 
The enema b watched at intervab as it flows in for 
ponilble obatructions, spasticity, mobility, ileo- 
cscal incompetency, etc 

TUs completes the examiiution and gives all the 
information avaiblile from any routine method. 

Aootm HAarvKC. 

MIUTARY SURGERY 

Bauer. F.: Shell Injurlaa la the Prcwnit War 

(Ucbcr Schuabesioaea im gegtnwarrtigrn KrirK). 
Tr. XI S'orth. Surg. C0mg., Goctcborg, 1016. July. 

The author, who had occasion to work in the 
reserve howital at Belgrade during the second Bal- 
kan War, during the present war in Vienna, and in 
other base ho^pitab, and further visited a series ci 
base homitals, gives a short review of the experiences 
obtained. 

I. Shell wounds are serious because a greater 
percentage of them arc infected than formeny and 
frequently severely infected. The reason for thb b 
that artillery wounds predomiiute. 

7. It b necessary to operate eariy in most brain 
injuries and so-called SUcksckursse. 

3. Most bullet wounds of the thorax are to be 
treated very expectantly. 

4. In all cases of penetrating wounds of the ab- 
domen it must seriously be considered whether the 
operation will not give the patient a greater chance 
than the expectant treatment. Numerous eicrileni 
results have been secured where operation was per- 
formed during the firrt few hours after the injtiry 
even if the conditions for operation were not alwajrs 
ideal. 

5. The ideal treatment for lesions of the extrem- 
ities b to quickly remove all extraneoaa matter 
from the wounds, remove all loose fragmeata, pot 
on a sterile dressing and a good fixation bandage, 
and send the patient out of the war zone. 

6. The transport system must be perfected to the 
minutest detaiL 

7. It b absolutely essential that competent sar> 
giosl men be retained at the front even in the moat 
advanced hospitab and dressing stations. 

Since it b not very probable that boUet woonda 
will become less suri^ in future wars, it b essential 
that in the organisation of military ho a pit a h the 
last mentioned reqtiirement be heeded. 

LAJi 



Following the examination of the gastro-inlesti- 
■al tract with the opaque meal the patient bprepared 
for the injection of the opaque enema. The bowel 
la cleaned by three small warm enemas given at 
ftfteen-minute intervab at least two and not over 



Wallace. C.: Gm Gangrene as Seen at the < 

nsnrli^ ScatloM. BrU, il. J.. 1916. i. 381. 

Wallace reports clevca cases of sas fs_,^ ^ 

records soose very laterastiag opiBiona b regard 
to the condition. 

From the clinical study of hb caaes and from tht 



I«4 



INTBRNATIONAL ABSTRACT OP SURGERY 



of Habft 



ol Caul OMM ukI oI abUltd 
Im ncil wii Um foBoviiif Im* 



Om 



it 1 diMMt ol iht mntdc*, tW 
mnfy mm wiik witlMmt a niMcIt 
~ ' ia Um 



falktlMH 

Tlw ImImi in ll» auljr tlifc* b ■ lonjHtudlaal 
OM nuwfaw ip umI 4owa the injured muaclr* from 
Um mm oTUm hmkm, TW wtmdm ftrat aflcctcd 
•rt Um mwtd mm. ■■< ttlficl mMMJOB to an intact 
WMdt ia rare, w that It b oaoaaal to ftod all of a 
•KglMaBt ol a limb allerted unlcM the mala blood 
MBBljr Imo baao nt off. 

Itot b b«t litUt twrffcy for the infection to 
pMi tnm OM WMdt to UMiUMr eacrpt when the 
pKMMVt btcowai wuMdmtt^ piat to intcHrrr with 
tha blood aivpljr lo tht mAfolala^ musclr* and thus 
* Ni ioqr prajra to the infection. Muvic* 
la rifld rnmiMniiMBii are capodallx 
10 dit. if vowidad. 
TW WMcloa bocooM naowutt from tho pitaence 

MM aipitaiit to the 
rrrpitatJoo b a oooBpaimthrclj 
ing due to tho aacipt ol na 
iolo tho Moolof Mid mbcuiAMOoa tbaooi cffwwta* 
Uoa OMV bo pMQipUhto at aa ouljr data bjr Moaaa ol 
the Kctlnaoope. 

A vaacvlar Icaioa JaeaflirifBt to caaM dMth in an 
aaiaiociad limb will be followed by the death of 
Um MaMie in an infected limb. 

It aoaaM that both the bacterial toxiaa aad the 
fM play a pan hi the death ol the maade. The 
advaaoM b at Me aa the musclc-fiben ahead ol 



of (M loaf haiora they 
tapraad, ahhaadi crep 
lata phoaaaMaaa Deinc < 



C 



i laiactioa aad latcrferM with the blood aapply 
tha Maadaa, that reodering them more aaaoept- 



to 

Ma to tha i iMrt*^ 

The Biicroaoopic appeaiaaoe ol oraade dead 
from cattiaa oo ol Ita blood aapphr b diflereat 
from that of a nraide dead from Mi o ctioa. Such 
aa ttamhMthwi ahoara tha bactaiia lo be between 
tha Maacla ihwi aad aot whhia theos. 
The coadMioaa u reprda treatawat are: 
I. The dradbtioa ahoald ahrajra be prcaerved 
whea poarfhia aad ahoald be helped ia every way. 
Taaiioa Imm affMloa or from fM by f rM iadaioo 
ihoaid be relieved. lauMctaat vaaaab ahoald be 
taiMi >iiil, if pnMlWa 
laddoa. or ablalioa. of tha Mo aa do d muade 



a. 

boltca 
oaly the 

J. Whea fM 
Hmhdtalaliothe 

tioaof tha 
4. Tha 
ataaabof 



toanaattha 



Mbboaaally 



If aaipadal 
aad STm 



oocan in a aagaMat ol a 
•afmeot it aaaily alwaya 
artanr b W ff'^'i"* aad aauMita- 
b the oaly coorae. 
of cnphatioa apart from other 
The atate of the 



of dead 



aHmbara 
ka bagih BMy ba 






0.1 TbaOaaaTkaac 
te (Zav Ffafi der of eaea 
KfbpT^M " " 



of W< 



MMr. •. Mte. Ckk.. 





J.W. 



Ia dboMBlin the irMlwaal of war 
fbdi ataua that ho doM aot «bh 10 
or aatbipda: adthar dam he wbh at piaaaat to dkl- 
dM tha vanooa p roca dar m adirocatad by Wrifht. 
Dalbat. Caml aad Dahia. m ohaervaikMa m to 
the vahM of aadi wuhedi are aot aafBdent to war- 
raat coadadoaa Jait yat. 

Saefbdi*a objaet b to weigh I 
aad dbadvaatafM of the opea tiaataMBC of 
la the Uaht of ma owa pcTMaal < 
tor of alarge deariag hoaphal. 

Attaaapta have boea ouda to give opaa 
traatflMat a adeatiSc fooadatioa aad to 
practice from the theory. Saeiich faMadoaaBy 
avolda theoretical ooaaldaffatlaaai aad ooaSaM 
himaelf entirely to the regioa of piaclloe. Ia war 
aurgery nothing but practical iiiMaaiM ceaai. aad 
the aanBoa caa aa oaly accowBai to tha oai d lUu a a 
priaaat. Hera BMre thaa abtinMM a aaoMmfal 
reaolt b tho oahr vaHditaadardfor tha employ- 

from laife hoapital oMterial, oMatly aerioaaly woaad- 
ed patieata. la thb hftfpltal the opaa aNthod of 
treatment had already been la om lor oeaM thaa 
and with extra care and ikUl had baaa bioii«ht 
to a great deoaa ol parfoctioa. 

At Saefccra iiat vWt to thb atatioa he wm fav- 
orably impreaaed bv the open treatoMat OMthod, 
but decided that it would be beat to form hb 
judgment from the reaolta of primarfly a a a r l eft o d 
apcUicatiooa of the method. In apite ol the favor- 
able exterior conditions, and in apito ol hb own 
favorable attitude toward it, Sedbch ooold aot 
coaviace hioMelf after aeveral weeka ol daQy expo* 
rieaoe that the opea wooad treatoMat wm aay laal 
advaaca, or that it had a fatare before it. Tha 
advaatafM daioMd by thoM who advocate the 
open treataMat ol wouida are: (1) diaooadaaaaoe 
of tampoaa aad draiaafa; (a) avoidaaoa ol pafarfol 
fhanging ol dremiafi; (3) qidck abatenwat of fevar; 
(1) good graaabtioa: (5) avoidaaoa of tha bad odor 
of wooada; (6) effectiva atraBte afalaat tha badlaa 
pyocyaaeoa; (7) favorabia uuhMaoe oa fM pldaf- 
moaa; (8) reatnctod OM of dnadafi; (9) ma work for 
theatafl. 

*Jatiach coaalde ra each of theM dafaaa aad m a 
rule doM aat iad that they caa bo aappoitod. Aa 
rafarda taaipoaa aad drahM he tUaka that la prac- 
tice Umm aia actaally aMd bv the advocatM of the 
lathod aad that ia order to avoid the alow- 
of ipllhdiMllna by the ooea traati 
I advocatM an adaf aaivm 1 
Than b ao proof that clthar badllM pvocyaaaaat 
fM pUefOMaa are better combaiod by the opi 
tnatmaat thaa by the older nrrlmlaa moti 

Tha iaal camdtmiam of Saaftirh an: Tho 
woaad tnatamaft hM aa iMpowani advaatafe wear 
tha occhMJoa h aa d ia t . aad caaaot bo daa ciih ad m a 




GENERAL SURGERY — MISCELLANEOCS 



i6s 



wooadt. Tbe •dvau 

IMwuliifiilniljr ct MM 
CMUbkiaMof 



«C Um BMlbod are pi«- 
iraal sfttare. Only in 
Midi M wooads in the anus 
aad in the bladder, baa opn tg—tmrnt a really 
higittr value. Open trratrnwH lMa» however, som- 
eraoa diiadvantacc«. the moat prooooaoed ol 
which ia the vciy much delajred, slower r e co v ci y ol 
the wounds with a oooaequent injuriooa effect 
later (unaiooiM. 



I 



The advantagca offered by thia method are not 
Bcot enough to balance the disadvantat>i> See- 
Mch doca not therefore bdieve that it haa a future, 
b«t would accord to it the character of a help in 
an cmef|ency. It b not necemary to change our 
viewa concerning the suitability of drainage and the 
mschaige of complicated wounda. The aoveretgn 
method of the treatment of woonda upon the battle 
Md b. and remaina, according to Scdfisch's convic- 
tion, the prafcmionalhr and careftilly applied 
o c c luii on bandage watched by experienced aariat- 
aata. Fixation, aa taught by von Berimann, re- 
■mina the strongest weapon in the fignt against 
would infedioo. W. A. BanniAM. 

L^ and Grand, J. le: Primarr Extractloa 
of War PioJectUea (Dc rcxtxartMo primitive 
dca pmjaolflm da gnerrc). Ly^u eUr., 1916, xiii, 
$37. 

The authors state that today there is a consensus 
of opinion as to the necessity of immediate opera- 
tion on all war injuries except in the case of per- 
foratbig bullets having left only two smaU orificea. 
Eapedally b there agreement as to the neceadty, 
or at least as to the very great utility, not only of 
opening up the wound, but extracting the projectile. 
Snch complete operation should always be done 
if the snnpcal means are at hand and there b no 
contra-indfeitioo. The practice adopted in the 
anthors* ambulanre service for many months past 
b immediate operation for ever>' penetrating wound 
wUh an included projectile, where there are no con- 
tra-indicationa. 

Of an methoda of loralixing and extracting pn>- 
jectilea the authors prefer soigical extraction under 
the goidance of the radioacopic screen and they 
think it superior to radiographic or other methoda. 
They think that the advantages claimed for radiog- 
raphy, i.e.. that it does not expose the suneon to 
the harmful influence of X-rays and that it ooca not 
aeceaaitate a specially darkened operating duunber. 
have no real weight, as both can be obvialed, and 
are more than outweighed by the advantage of 
the surseon having the picture of the projectile 
immediately under his gaxe in removing the pro- 
jectile. From their experience of both radiography 
and radioscopv the authors have readied the C0B> 
viction that the latter is simfiler, easier, and nwfa 
surely and rapidly e B f a cinus . 

They have attenmCed S57 extractions of project 
tiles by thb method aad all have been socceasf uL 
These indaded $a extractions from the upper 



limb; 168 from the lower limb; aj from the thorax; 
and 14 from the head 

The rnnflnrfoa which the aathors finally anive 
at is, that eviwHBf WMy MnaB projectilea deeply 
ewtf>fdded in the maedca or bonea and not giving 
taoiriile, encephalic pr o j oc tB c a aot acceiaibte by 
the wound, and for the time being intrapulmonary 
projectilea, all other projectiles ought primarily 
to be removed inuaediatdy oa arrival at tae aaibo- 
laace if there b a good radiologic aad fanical ser- 
vice. The preference b given to the extractioo under 
the intermittent control of the radioscopic screen. 

W. A. BaxmuK. 



>ui jaqr ol War, and 
(Ibcaljrain Anapliy* 
EgKaireiBa uaa sdae 



HcMe. W.: Fibrolyain In the .Suf 
Its Danger*: Kemarka 00 

huda (Fibrotysia in dcr Kri.^ 

Gcf akraa aahat daern AahiM aslMr ma fffteelyil 
aaaphybxie). Ardt. f. Uim.Ckk., 1916. cvffi, 7a. 

Hesse reports 00 the use of fibroljrsin in war sur- 
gery. Thb subataace, which b formed by the 
chemical union of thioriaamin aad sodium salicyl- 
ate, was first prepared by Mendd in 1904. It aai 
beoi extensively used ia Germany in dcatriaed 
healed gunshot wounds when the scar tissue inter- 
fered with function, as it effects a softeaing of the 
scar. According to Hesse, its use b indicated 
in (i) motor duturbaacca in various joints, wh^ 
such are the consequeace of a shrinkage of the soft 
tissues, or due to a coalescence of the soft 
with bone, or a cicatricial coalescence of sinew 
muscle groups with inhibition of their individaal 
motility; (2) in scars which are sensitive to pressure; 
(3) in disturbance of blood drculatioo due to dca- 
trixation; (4) and in certain pleural growtha. 

Within the range of these indicatioaa favorable 
results were aoted in only about jo to 50 per cent 
of the cases. Fibrolysin b contra-indicated as long 
as there is the possibility of latent virulent pus pro- 
duction in the scar, as under such circumstance there 
b likely to be a renewed inflammatonr procem with- 
in the scar. In three cases of tab deeoiptiea 
two deaths resulted. It is, however, by no oseaaa 
easv to detect the presence of latent poa in the scar 
and it may be easUy overlooked, owing to the ab- 
sence of dinical symptoma. The age of the scar 
docs not exdude the possihflity of a virulent p«i 
producer within it. In cases oh s u ve d by HesM 
in which injections ol fihrohrsin were amde iBractly 
into the scar, the pwm i nyl i n n waa Jnstified that tt 
waa the cause of a t euip e sta o a s iafoction and fatal 
issue. It b therefore a sale rale never to iajea 
fihtolysia iato the scar itaett. Soaietiossa dittarb- 
aacea of the geaeral condition ol a toadc aatara are 
obs er ved which are a leqaeapi ol iacrsased acar> 
tissue development. As a conseqaenoe there b 
ol the blood with alhaada aa a hv-prodact, 
explsinahle by aaaptqrlaxis. dwich 
phylactic symptoms are not an in di cati on 
continuation ol fibrolysin trcatawat; they are 
rather progaostic ol a favorable result ol the thera- 
peutic soccssa ol fibrdysiB aa they are the < 



|66 



INTERNATIONAL ABSTRACT OF SURCKKV 



MK« of MMpkylMlIC qr«|ll«M it iW lipfriui o( 

of tcartlMM. 

W. A.BMtaMii. 



Pkfk M 



of TvfftaiM. 



dCI*^ lOiAw 



TW pwirMitioi of teUiiii* %M«tUaiM» lu «^ciTv 
Um •itoBiloB of wfiionoa aiiluy MHnnr oad It b 



01 UM doMly coaii« 

■di by p wph yto ctk inJtctioM 

«• oQt of Um gmt 



Mit to lUU tlM tW coMiol of 
nHfu^f*^ of w 

of MtilOlto «n bt NfuU M OQt of UM gTMt 

tcfcunplM of piiwllw MididM Im dw pcoMnt 
worid war. 

Tllift llltlt book diob wiih tbe (onw of tetanus 
00 Mb«n»>H mad imtcd in thr earlier part of the 
ll ifcuh alw with the abnormal forms of the 
as BOlcd and much better understood at the 
Ifaae; fonns that are far more frequent t han 
iffsoos onifMct. Tbe atypical varieties of 
rdonod to are those with manifestattoos 
of Ibo dlssiii rwiiMid to tbe bead, and others Id 
vWdi tbe af ocUoo b cooliocd to tbe limbs. 

Tbe cephalic fonns are tliose (i) with involve- 
ment of tyt mosciss, and (a) tliose in which the 
Imnj^li— si or other cranial nervr« may be involved. 
li| the l ocal in d forms affecting the limb* the aflec- 
tien may be moaoplBgic or proplcgic; there are 
olbtr Idrma fai whidi mmclcs of tbe trunk alone 
are tnvolvod. 

In tbe preface Profcmor Wldal caUs attention to 
tbe cmfibnsis arliicb tlw aatbon plaoe on what they 
•nfo taUBoa of inrnmnlsis Immon i Mti on. They 
MMT to tbe atjrpical ana partial forms of tetanus as 
a tsonlt of iMMbdent vaccination with antitetanic 
serum in tbe same way that we refer to cases of 
attenuated typlwid (ever from insufficient dosage 
wtob serotbctapy. Tbe atsrpical forms mentioned 
point to tbe nooessity for further dosage in the 
cliBicai bistocy of these tetanus CMca. Tbe authors 
OM iMbtmu on timely and snffkisnt proplqriactic 
i^fictiooa in war woumIs as tba only tmstworthy 
■iti Mjdof preventing totantm 

SirWBIiamOricr rapofts that bo bos seen o cases 
of so-called local tataaas tknet Us attention has 
bacB called to tbe subject. According to him the 
cassa faff into three groups: (i) local spasm of a 
Hmb p ffscs ding by several days tba onset of severe 
tilaans; (t) trae tofaHord tetanus conffaod to one 
Hmb, or to a groop of oraicies, or to both legs 
Oaoovcsy is tbande in iudicMSs) i (s) psondotctanns. 
Oll« waraa m tbat every masda tpum foOoviag 
a woMid is aot tilaana. At ooa of tbo coooaltatloaa 
tba ptaciilionir mftioBwl a cast of sappoisd 
TW aotaastaiod t bat tb a ipasma to analog 
■MdfaMly iflar a icfitcb rscdved from a 
I tba tealplln al iaa by tbe nurse sug- 
f— ctional apama. Another 
to oat log, varying »tib 
rben watched. The 
patdowBaaaaoanda. Sir William 



MSiod a fona of 
notlaiM bad ctoaic I 



*««ir> (ttftbor tbat poaaiblv these arr cases tM the 
laffai ipaMi, aaaodaiad with wcmads. such as ara 
wBcvsoau ov vaosasai* 

Last Aimnst a wsmotaadum on tetaaos was 
laaaod by ibt war oflka roniinss oo tba study of 
lataMM, which formed a gaidatoaBawfaoM In tba 
Biitiab army for tbo propl^ylactk tiaatiaant of 
tetanus. A r ovia ad drcaiaf baa lacaatly ba» iaaaod 
on tba aama aubjoct by a tptHiif tataaaa com- 
■dttaa. Tbe projMactic iaioctioo of aatllMto la 
BOW tba nila to all war wounds, and altboogb tbora 
ara caaaa atlU occurring, the disease b aow aaM la 
aaudler numbers. 

According to the circular there b stroBg aipori- 
mental evidence that the immunity c o Bf awad by a 
primary tojection of aaUtosto b toot to about ten 
days. For tbat reason it b ronshlawid advisable to 
give a second oabcataBoooa iafacUoB to aO aeptic 
wounds at the end of aevan dajra; aad further to 
wounds following a dironic course, cansed bv shell 
fragments or bombs, a third and fourth tojection 
should Iw given at intervaU of seven days. 

The liangrr of anaphylactic shock b said to be 
negligible when propbjflactic doses of soo U. S. A. 
units contained in j ccm. of horse serum are sdmto- 
istered subcutaneously, whstever tbe interval after 
the precoding tojection. 

IVsafa la fr^pkyhOU or pfttmtim Jras l s Mal tf 
tdamm. Tbe meniorandiun recommends tbat tbe 
primary dose be given at the dressing station, and 
the subsequent doses at home hospitals. Tbe 
ordinary vtal contains i.^oo units of tetanus aati- 
toun, of which one-third should be administered 
subcutaneously to each wounded man. Tba scrwB 
b sseptic and, moreover, it contains an antiseptic. 
It b not neoeaaarv to sterilixe the syringe after aadi 
injection, but a freshly stariiaed neadla aboold ba 

WhoB aboBt to operate at tbe aiu of a wovad, 
altboogb tbe latter ba bealad, u a lem tbe piavioaa 
dose MS been administerad at a sbortar iatarval 
than seven days, a prophylactic iaJactioB abovld 
tovariablv he mven before operation. Tba pcacau- 
tionary tojection abould ooiviat of a dBBa aab- 
cotaneoM iojection of tba ornaary piopaviactic 
dooe of ^(oo aaita adnlBialafad two daya oaf ore 
opcratioo and preferably totramoacalaily. It 



takeaaS boars for tbe anHloato to be abaovbod when 
admtol a l a ia d aubcutaBoonely, aad twalva hours, 
iBtraaraacBlarly. 

Pwcaationary tojection before operatioo b asc ae 
aary to ward off the poaaibfliiy of lighting up dor- 
it tetaaua badlli tbat amy Ue buried to living 
tbat are todiffarent to their growth. It 
bo rememberad that the aaaeroboa, like 
tetanus bacflU which are saprophytic to habit, osay 
live without propogatiag to aaaa wonada for two 
and three moBtba witboBt oabBd t to g tbo dtoical 
manifcstatioM of tba dieaaoaa wUcb they caaae, 
when tocatad to devitaUaad tiaaBsa. Ueaoa tbe 
for precaatioBaiy pnipbylactic doaage to 



GENERAL St'R(»RY — MISCELLANEOUS 



167 



be « M ployed when about to operate at the tite of 
a woowL 

Tbe memorandum next deals with the antMeptkt 
used in the preventive irralment. It is wcU known 
that anaerobes grow with much difficulty in the 
pf ea aac a o( oiidtehtg agent » like hsrdrogen peroxide, 
potaaahim permanganatr, chlorine, and solution of 
wdine. and for that rruon ctinicians have sought 
to treat the infection locally by irrigation and by 
injecting into the tisauca, weak solutions of these 
agents. The results have not been satisfactory. 

DiagiMim. The dasakal tymptoms of tetanus 
inch as triamus, risus sardonicua, opistothonoa, etc., 
in those who have been treated by prophylactic 
iniectioQS of antitoxin, are very sdoom seen. The 
duiical evidences of letanua are confined to local 
spastic rigidity of the wounded part or limb which 
may permt for weeks. 

The importance of early diagnosis is emphasized 
since all ofadcal and experimental evidence goes to 
show that mcccaaful treatment diminishes rapidly 
with the lemth of time after the first symptoms nave 
been observed. Among the earliest symptoms of 
tetanus are spasticity and increased reflex excitabil- 
ity of the muscles near the wound. In these cases 
tbe toxin reaches the spinal cord primarily by the 
nerx'es which are connected with the seat of injur>' 
and therefore the motor ner\'eceUs which govern 
the muscles about the wound will be the 6rst to be 
affected. Spasticity and rigidity may precede the 
other symptoms of tetanus by many hours. For 
thb reason, the assistants and dressers are enjoined 
to report to the surgeon in charge, the first occur- 
rence of rigidity, twitching, or local increased reflexes 
which may be provoked in response to gentle tap- 
ping or pressure. Other early symptoms of diag- 
nostic value may be an anxious look, pain in the 
back or neck, sore throat, general restkaanesa, 
unreaaonable outbursts of temper, insomnia, violent 
headache, excessive yawning, complaints of spasm 
ia the limb injured, stiff neck, difficulty in swallow- 
ing without recogiUaable cause, stitch in the side, 
profuse local or general sweats, and difbciUly in 
micturition. 

TktrapetUic or curative treatwunt pf tetanus. 
Success m therapeutic and curative treatment after 
the onset of symptoms depends on properly admin- 
istered intralocal injections of antitoxin given as 
soon aa poastble after the first symptom has been 
noted. An hour's delay may mean the difference 
between sncccaa and failure. Rigidity and hardncaa 
of the muadcs around a wound may be present for 
davs or weeks before the occurrence of trismus. 
When the rigidity appears it will not do to employ 
the slow method of absorption of the antitoxin by 
the subcutaneous or intramuscular method. An 
intrathecal injection should be made aa follows: 

"The patient should preferably be uiKler a geiteral 
anesthesia. The skin over the area of the fourth 
and fifth lumbar spines should be paintr<i with iodine 
or Hennaed with soap and water followed by an 
antiseptic. A spinal needle and a ao-ccm. syringe 



should be boiled in normal saline, and the suffBon 
must observe throughout the most riforooa taignic 
procautiona. 

"The patient b bent head to knees, so as to 
proaent aa fully a curved back to the operator as 
poaaible, and the poaition of the fourth lumbar spine 
aacertained by drawing an imaginary line between 
the creats of the ilia. 

"The tip of the finger b placed on the supra- 
spinous ligament connecting the summits of the 
spinous processes of the fourth and fifth lumbar 
vertebrr. The needle b inserted about three- 
eighths of an inch to one side of the middle line and 
directed forward and slightly upward and inward. 
If the needle strikes the bone it should be withdrawn 
and a fresh attempt made. The canal b reached at 
a depth, on an average, of about 9.5 inches. The 
trocar b withdrawn and about 20 ccm. of cerebro- 
spinal fluid aUowe<l to flow out into a measured 
vessel. The syringe is then fitted to the needle and 
the serum injectetl. It b important that the serum 
be heated to the temperature of the body and the 
injection made very slowly. 

"The canal can also be reached by pushing the 
needle through the supraspinous ligament in the 
middle line halfway between the two spinous 
processes. If several injections are to be made it 
is well to choose fresh sites. Blocking of the flow 
of the cerebrospinal fluid by a blood-dot may be 
overcome by reinserting and withdrawing the 
trocar. 

The bed should be tilted at the foot and the pillow 
removed for an hour or two alter the injections. 
The foregoing direct attack on the toxin in the 
neighborhood of the central nervous s>'stem should 
be supplemented by intramtiscular injections in 
order to neutralize any toxin in the blood and to 
prevent any more of it being taken up by the nerve- 
endings in muscles. Subcutaneous injections may 
be practiced later to keep up the antitoxic quality 
of the blood. 

Intravenous injections are not recommended 
because of the danger of anaphylactic trouble which 
b prone to occur after thb mode of adminbtration. 

Dosage in the therapeutic or curative treatment of 
tetanus. The value of the curative treatment by 
antitoxin lies in the administration of large doses. 
The intrathecal injection should correspond in 
bulk to the amount of cerebroapinal fluid withdrawn, 
which as a rule should not exceed 20 ccm., and in 
cases where little or no fluid b drawn off, the 
amount of scrum injected should never be more 
than 20 ccm., and thb should be injected very, very, 
slowly. 

If the serum b of the strength of 150 uniu in 
I ccm. the patient will then receive a dose of aomn 
3.000 in ao ccm. When the serum b of higlMr 
potency — say 800 units to the ccm. — the pntieat 
will receive 16.000 units. The high potency aefvm 
b always preferable for intrathecal injectiooa. 
At the same time that the intrathecal injection b 
given from 5.000 to 10,000 units should be injected 



|6S 



INTERNATIONAL ABSTRACT OP SUROBRY 



•ad 3^000 to s^MO Rfi alio bt 
mfy, 

TW hnwilwcd jjJicttoM — y bt wptind daily 
lor ilMot to ivo dam, aad Um tMnuMMidir im 
• aay bo coMiwMd ddljr or olioatr 
10 Um MvoriQr of tbt ^rapioM. 

labia ii ghno ■• 00 onaolt of tbt 
wbicb bat baM oo^ployoa ia aadljr 



aad wCmafbad 




tfiatawoi above 
qrmpCoaiatic 
of tba adaduitfaiioo of 
Tba HMH miuble b 
naa tioartar gfaia tvtfy f oor boon, aod nat poua^ 



ibaMMtb or loctoHk CarboOc add. aad 

la cbrtaliiif ipaaaa, tbay bavt ao conuivt liact. 

Sargtef trmtmml tf Urn wmmi. To ampotau a 
Uaib or oadia tba wooad la a caat of tctaoitt it aot 
loobad ttpoQ wlib faver. TiMgr aio of ao avail, 
aad dink at a* well aa oipaiiBMalal wMmf poinit 
to paaatblc daagcn from owor lalaKawaco. 

Tba BMBMimodum rccommeodi ibat aiparta la 
tataaai ba datailcd to aitist io tba twatmaat of all 
caaaa^ T^aaa oftpaia tbmilil ba aaar at baad, aad 
praaptly aotliad aa aoao aa a caaa la aiwpectad. 
Tbay aia to aopanriia tba iocofding of caaaa aad 
laport opoo aay aboonaaUty of bcbairlar of tba 
aatltctamc teruro used. Toa mdal ceandttat 
laferrcd to ia the brginning of taa maaioraadiim 
•alidu tba co-oparatioa of all medical oOcaia la a 
coUactive lavcatkatioo, and we bava oaat coa- 
idaarc that thdr Ubora will continue to Mag fortb 

cUaical rvidrnrr of value. I^iru A. LaGi 



GYNECOLOGY 



J .4( 



In tb« lYHicnMic 
i/ Alt., igto. Uvti. 



Jacoteoo. J. It.! lUcHiC 
of UnriiM Canc«r. 

In early or operable case* o( uterine cancer, the 
beat rcsttlu ate obtained from the radical ahdmnlnal 
operation. 

Owing to the dMhwacc in malipianry of uterine 
cancer, the type of aaam piweil ibould be de- 
termined whenever poerible. Cancer of the vacinal 
portion and of the body of the uterus should be 
treated preferably by opermtion. 

What shall be dooe with the borderline cases is 
to be deCcnnined by the operator's judgment and 
his eiperi i Hce with the radical abdominal opera- 
tion. 

Until radium, roentgen ray. or Percy's operation 
have proved their superiority to estahUahed methods 
of wnyiT^ treatnaent, their use shoold be restricted 
to the inooerable cases. 

A comb in ed form of treatment, that is, operation 
with radiotherapy, b a method of demonstrated 
value. Systematic irradiation with roentgen ray 
or radium should foUow every palliative or radical 
operatioa for uterine cancer. 

EowAKD L. ConxELt. 



Berlulnr 



. C. and Boonejr. V. : The Radical Abdon- 
Operatkm for Carcinona of the Garrlx 
Uteri, brii. U. J., 1916. ii. 445- 

Thb report is based on one hundred cases with 
results from the x-iewpoint of absolute cure or five 
years' freedom from recurrence. 

The operation consisted in the removal of the 
uteras with the cer>Hz contained in a bag formed 
of the upper half or two-thirds of the vagina, doeed 
hf a cuunp specially designed, also removal of 
ovaries, faOopinn tuba, broad ligaments, parametric 
and paravafmal tiMoe down to the upper surface 
of the levator ant. and the glands aiid cellular 
timue occ np y i ng the obturator fosse and investing 
the external and internal iliac arteries and vetns. 
The ureters were entirely isolated throughout the 
anterior two-thirds of their pelvic coune, and some* 
tfanes part of one ureter was resected and the upper 
end implanted in the bladder. Sometimes a portion 
of the bladder was exdscd when not leparable 
from the cervix, and where carrinomatona i^nnda 
about the external iliac artery and vein cditod, 
diiwrtion was even extended to the bifnrcatioo 
of theaoru. 

The one hundred cases consisting of those up to 
the borderline of operabflity had the following 
reeolts: 



Died of the operation .... 
Died of recurrent growth 
Died of other diseiues 

Lost sight of 

Cured at the end of five years 



i 

7 

39 

100 

C. J. STAIOf. 



Deavcr. J. B.: Operattve Traatmcat of Flbro- 
myomatoua Uterine Tumors. J. Jiat. U. Au., 
1916. Uvii. tji6. • ,. 

General interest in the question of the treannent 
of myoma of the uterus has been rekindled by the 
enthusiastic claims of advocates of the roentgen ray 
and radium treatments. Surgery has foo^t and 
won the battle against the old ideas of the harm* 
kanese of the majority of these uterine growths, 
showing that in many cases thev take on activity 
after a period of quiescence, that they undeifo 
malignant degeneration, that they may produce 
harmful pdvic and abdominal lesions, that they 
predispose to carcinoma of the uterus, that thev 
produce a variety of harmful pressure effects and. 
in short, that anv given series of women who are 
the subjects of thew growths will in time show a 
large percentage who suffer from one or more of a 
great variety of complications that are more or leaa 
disaNing or dangerous to life. 

Now we are confronted by radium treatment, for 
which more extended claims are made, and we are 
asked to believe that it will not only control the 
sjrmptoms, but also cause a disappearance of the 
growth in many instanres It is obvions that a 
considerable time must elapse before the radium 
treatment can be stamped with the final verdict of 
historv. A patient treated with radium, e\'en 
though symptomaticallv improved, stOl has her 
fibroid, for the claim that such tumors dJMppiir 
under the influence of the radiationa cuuMt* be 
taken seriously. 

In the author's opinion, we are now justified in 
asserting that both the roenlnen ray and radium 
ha ve faOed to demonstrate specfik power over fibroid 
growths and, therefore, must m placed in the 
category of symptonaatic forms of treatment which 
acgomplish good resulu in orr a tinna l cases, like the 
use of corro siv e plaster in cpithsHnms, bnt, when 
need as a measure of fenerai auplkab flii y, irti do 

thendi 



great harm incensing 



radical tnataMnt 



uvof 

and exdting false hopes of non^iperatlve auc that 
may deprive many of proper treat men t. In all 
cases the treatment is expensive and often tediona. 
It does not Mfesuard against future trouble. There 
is no reason to believe that it can aboiiah the 



169 



•TO 



INTRRNATIONAL ABSTRACT OF SURGERY 



aii«it«d lode dbct of tmtalm nyoauu oo tbt 
iMMt ud poafthr oiiHr otpas. 
Urn opmtiM lor ttwold tanor ol ibe uitrm ha* 

bOM OM of Um MOtI Ml lrfMUMy in *ll SttffMy. 

If porforwid OO optfoblo potlnli oi • limrlx tooaoo 
tkt aortolity b caeoodliidy low, the rr*ulu bring 
■loMil oalfonoljr food. wImi curr b imlicatc<l. 
oraipiooMik tfoiUMOl km ao i 



vogiool ■■yotaiiooi of Um otonM wiihoot rrmovml 
of Om ioImo ood ovoifao, jts Mpravafinal ampou* 
lioot of ikr ttimtft with rrmovij of both lube* and 
ovorii*. and us Mitiravaciaal amputaliont with 
poftiol maoval of the toMO tad ovaHii. There 
were oq aaafdele ahdomiaal hyoloioctoaiica, m 
vofiaal lqnieractoad«, aad oj ibdnmiaal myo- 
TW aMfftaUty waa 1.75 |Mr OMU 

Edwaoo L.Cooiittx. 



.€.1.1 A Kt po r I of Oao M— iwd O aaii m thm 
of WWaaayiaMiia Unri SaMoctvd to 
J. Am. M. 4$$., toi6, livC I'lj- 



i popcr b boatd o 
of ■bfoaijroauua 



uteri Mibjcctcd to 



iocativo 
oporaitoa. 

Ilaligaancy ia the pdvic organa and degenerative 
ia the tuaMW wen foood aa per the following 
Thcat took place in ji patienta. which b 
the ptmialatff aaoally rrported. 

iatttratioa 

corporia atcn . . 

ocrtridi uteri i 

CaidaoaM of ovary with eitmsion to utmts 



1 1 
rywMBatooa de fener ation 

Nerrosis .... 6 

•00a I 

o patients, 6j were married, 1 1 widowed 

Of the 74 who were or had been 

i per cent, had borae children. 

. «^ pfoccduret carried oat ia thae caiea 

>4 MKMavagiaal hjriCcfocUMaica 64; paa* 

ao; vaffaad kyotModomy 




aMUfpiaacy, 
laoctaiioa of 
nathcca 
Bcridci the opciathro 
laawfBlod, oovaial of the patieata had 
doat at tho thae the tuoMwa were re- 
Oao COM had a plailk opctatioa. a ihortca- 
iac of tho laaad lipMHat.aad aa appeadkoctoonr 
toaddhkatotheaiyaaMctoeiy. 

Tht prioMiy Mortaliiy waa i ner ccat. Oao 
caae, that of a pale, aooh patimi. did wdl the firtt 
foar dojn, whta har ipadal aufae gave her a bath 
oa a aiMr'a day with the wfaajpao vldo open. *he 
pwplhr d ii w thipid a doahit paoaaaala and died 
oalhto^hthday. Aorthtr patiwH dotifaptd wal 
aad died s> days after opmUoaT Sho 
fiaai the operaiJoa, hat rcaMiacd at 



aieiucai tfoataMai: aa ibe died la 
ihe fatality b iadadid hi the Mii«. 
the fMolu of the caooa aaMoelfd 
; oao of tho aMM laiportaai facton 



the hoaplial for aiedical tfoataMat; aa the died la 
the iaatiUHJon. the 

la laviowiag 
to hyMoroctoanr 

f foai tho enadipiolat of tho patltai ia the 
of »uffrring ffom tho aitiidil aMaopaan. Tho 
patient* »cfenMMttoaod cloiilyattothrai aytimaa 
aad ovtfy ctfort aMdo to CMrify theai acouatoly. 
ThodofMoof tho BMaopaanl lyamtoaw haahoea 
oieaHB ano avo 



vonr adM, adld, awdiratoly aevoio. aad BMihod. 
(If the patieau iuhjactod to hyateroctoanr. in 
the meattrual faactloa waa atfll artlvt. Of these. 



71 



in I a oae or both ovarica were allowed to reoada; 
in 6 both ovarica; in 4 the right, in t the left; < 
are dead; 7 caaaot be traced, which Icavoa 4* 
traced patieata who had both ovariaa 
Of theee 4S caaaa. 0, or 18.7 per coal, had ao 
pauial aya^MooM; in 8, or 10 J per ccat, tho tfm^ 
tooM were very mild; in jo, or 41.6 per eeat, tao 
aya^MooM were aiild; in 7. or 14-5 per caat, tho 
qra^Moaw wore aMidcrately severe; aad la 4. or 8.j 
per ceat, the qraintoaia werr marked. In 77 per 
cent of the caaca tae disturbance aa a result of the 
artificial laeaopaase varied from ao symptoaia to 
mild discomlort. 

Of the I a patients in whooB oae or both ovariea 
were allowed to rrmain. 10 have boea traood. Ia 
S. or so per cent, there were no mea opo ai ol tynp- 



toms; in a, or 20 per cent, the ymptoaw were vonr 
mild; in 1. or 10 per cent, the sjrmptoaia were ami* 
eralely severe; while in a. or x> per cent, the sya^>- 
toma were marked. Time two patienta were pra* 
nooaced neuraathenica before tne operatioa. aad 
after operation they complained greatly of tho 
menopausal nm^Moasa. laeir phjrskal coaditioa 
b good aad they have beea cared of all aywiHaaii 
caused by the tumors. They would, no doabt, 
have complained to the same extent had they goao 
through the natural menopause. 

Of the ;8 patienu alive aad traced, the reaalta 
ha\T beea aa followa: Oae patieat, whflo carMi of 
the pelvic Icaioaa, had aa fadocthm of the faMbloa 
with a hating heraia. Oae patieat, aftor s 
plaatic operatioa, a aiy oaioctoaiy. aa ai 



tomy.aad a ahortoaiagof the rooad ligaaeata,coa* 
tiaucd to have awtrorrhagla, which was coattoHod 
by lOiBlftia ray treataieat, aad b aot coariilwiid a 
aargical caia. The coosbiaathM of 
ideal. There araa ao OKOiO for a 
which woald have caatwdlod tho 
taoMMO wore mboO aad the patieat ooa^Mratlvoly 
yoaag. Oa tho other haad, the rocatgn rays woald 
aot have cared the laocratioaa, the displaoeaMai» or 
tho fhnm k appeadf